title: Treatment of tympanic membrane perforation using bacterial cellulose: a randomized controlled trial.
abstract: BACKGROUND
  Promising treatments for tympanic membrane perforation closure have been studied. Therapies derived from tissue engineering probably eliminate the need for conventional surgery. Bacterial cellulose is presented as an alternative that is safe, biocompatible, and has low toxicity.
  
  
  OBJECTIVE
  To investigate the effect on healing of direct application of a bacterial cellulose graft on the tympanic membrane compared to the conventional approach with autologous fascia.
  
  
  METHODS
  Randomized controlled trial. Forty patients with tympanic membrane perforations secondary to chronic otitis media were included, and were randomly assigned to an experimental group (20), treated with a bacterial cellulose graft (BC) and control group (20), treated with autologous temporal fascia (fascia). We evaluated the surgical time, hospital stay, time of epithelialization and the rate of tympanic perforation closure. Hospital costs were compared. The statistical significance level accepted was established at p<0.05.
  
  
  RESULTS
  The closure of perforations was similar in both groups. The average operation time in the fascia group was 76.50 min versus 14.06 min bacterial cellulose in the group (p=0.0001). The hospital cost by the Brazilian public health system was R$ 600.00 for the bacterial cellulose group, and R$ 7778.00 for the fascia group (p=0.0001).
  
  
  CONCLUSIONS
  Bacterial cellulose grafts promoted the closure of the tympanic membrane perforations, and were demonstrated to be innovative, effective, safe, minimally invasive, efficacious and to have a very low cost.
authors.affiliation: Graduate Program in Surgery, Department of Surgery, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil. Electronic address: fcasil@ig.com.br.
authors.forename: Fábio Coelho Alves
authors.initials: FC
authors.lastname: Silveira
authors.affiliation: Nucleus of Experimental Surgery, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil.
authors.forename: Flávia Cristina Morone
authors.initials: FC
authors.lastname: Pinto
authors.affiliation: Service of Otolaryngology, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil.
authors.forename: Sílvio da Silva
authors.initials: Sda S
authors.lastname: Caldas Neto
authors.affiliation: Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil.
authors.forename: Mariana de Carvalho
authors.initials: Mde C
authors.lastname: Leal
authors.affiliation: Medical Course, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil.
authors.forename: Jéssica
authors.initials: J
authors.lastname: Cesário
authors.affiliation: Graduate Program in Surgery, Department of Surgery, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil.
authors.forename: José Lamartine de Andrade
authors.initials: JL
authors.lastname: Aguiar
mesh_terms: D000328:Adult; D001705:Bioprosthesis; D002482:Cellulose / Q000008:administration & dosage*; D005205:Fascia / Q000637:transplantation; D005260:Female; D006801:Humans; D008297:Male; D013997:Time Factors; D016896:Treatment Outcome; D018058:Tympanic Membrane Perforation / Q000601:surgery*; D014945:Wound Healing / Q000502:physiology
chemical_list: D002482:Cellulose
keywords: Bacterial cellulose; Biopolymer; Biopolímero; Celulose bacteriana; Perfuração da membrana timpânica; Tympanic membrane perforation