title: Comparison of packing material in an animal model of middle ear trauma.
abstract: OBJECTIVE
  To compare the performance of absorbable gelatin sponge (AGS) with polyurethane foam (PUF) as middle ear packing material after mucosal trauma.
  
  
  METHODS
  Using a randomized, controlled and blinded study design fifteen guinea pigs underwent middle ear surgery with mucosal trauma performed on both ears. One ear was packed with either PUF or AGS while the contralateral ear remained untreated and used as non-packed paired controls. Auditory brainstem response (ABR) thresholds were measured pre-operatively and repeated at 1, 2, and 6weeks postoperatively. Histological analysis of middle ear mucosa was done in each group to evaluate the inflammatory reaction and wound healing. Another eighteen animals underwent middle ear wounding and packing in one ear while the contralateral ear was left undisturbed as control. Twelve guinea pigs were euthanized at 2weeks postoperatively, and six were euthanized at 3days post-operatively. Mucosal samples were collected for analysis of TGF-β1 levels by enzyme-linked immunosorbent assay.
  
  
  RESULTS
  ABR recordings demonstrate that threshold level changes from baseline were minor in PUF packed and control ears. Threshold levels were higher in the AGS packed ears compared with both control and PUF packed ears for low frequency stimuli. Histological analysis showed persistence of packing material at 6weeks postoperatively, inflammation, granulation tissue formation, foreign body reaction and neo-osteogenesis in both AGS and PUF groups. TGF-β1 protein levels did not differ between groups.
  
  
  CONCLUSIONS
  PUF and AGS packing cause inflammation and neo-osteogenesis in the middle ear following wounding of the mucosa and packing.
authors.affiliation: University of Miami, Miller School of Medicine, Department of Otolaryngology, Miami, Florida. Electronic address: Enrique.perez@mountsinai.org.
authors.forename: Enrique
authors.initials: E
authors.lastname: Perez
authors.affiliation: University of Miami, Miller School of Medicine, Department of Otolaryngology, Miami, Florida.
authors.forename: Ralph Abi
authors.initials: RA
authors.lastname: Hachem
authors.affiliation: Mount Sinai Hospital Icahn School of Medicine, Department of Otolaryngology Head and Neck Surgery, New York, New York.
authors.forename: Daniel
authors.initials: D
authors.lastname: Carlton
authors.affiliation: University of Miami, Miller School of Medicine, Department of Otolaryngology, Miami, Florida.
authors.forename: Isabel
authors.initials: I
authors.lastname: Bueno
authors.affiliation: University of Miami, Miller School of Medicine, Department of Pathology, Miami, Florida.
authors.forename: Stephen
authors.initials: S
authors.lastname: Vernon
authors.affiliation: University of Miami, Miller School of Medicine, Department of Otolaryngology, Miami, Florida.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Van De Water
authors.affiliation: University of Miami, Miller School of Medicine, Department of Otolaryngology, Miami, Florida.
authors.forename: Simon I
authors.initials: SI
authors.lastname: Angeli
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D004432:Ear, Middle / Q000293:injuries* / Q000473:pathology / Q000503:physiopathology; D016057:Evoked Potentials, Auditory, Brain Stem; D005781:Gelatin Sponge, Absorbable; D006168:Guinea Pigs; D013506:Otologic Surgical Procedures; D011140:Polyurethanes; D011897:Random Allocation; D014945:Wound Healing
chemical_list: D011140:Polyurethanes; C028279:polyurethane foam