Download Omneya El sayed Bioumy Ahmed_estrogen paper

The effect of topical estrogen on healing of chronic tympanic
membrane perforations and hearing threshold
Ahmed M Seliet PhD, Mohsen M Abdel Razik PhD, Naslshah G Kazeem MD
,Ahmed A Ibrahim MD, Omneya E Bioumy (M.,B,B.,ch).
Department of otorhinolaryngology,Faculty of medicine
Benha University,Egypt.
Abstract
Background: Tympanic membrane (TM) perforations can arise from a variety
of causes; Major causes include trauma and middle ear disease. Surgical treatment
requires higher costs, more effort and surgical risks. Therefore, many investigators
have studied topical use of substances to facilitate TM repair. Estrogen can influence
the various phases of wound healing in cutaneous repair; Topical estrogen application
may influence the repair of TM perforations.
Aim of the work: The aim of the work is to evaluate new procedure for
repairing of TM perforation and improving hearing threshold after 30 days using
estrogen paper patch.
Participants and methods: After getting informed consent, patients were
randomly allocated to two groups. One group was treated with estrogen paper patch
(paper patch impinged with1% estrogen ointment to act as the study group), The
second group was treated with paper patch impinged with local antibiotic ointment to
act as the control group (we used 1% tetracycline ointment in our study).
Conclusion: maybe there is significant and promising result for estrogen paper
patching as a method of repairing tympanic membrane perforation.
Keywords:
myringoplasty.
estrogen,
paper
patch,
tympanic
membrane
perforation,
Introduction: History always provides an insight into the future, the history of
tympanoplasty nearly sums up the history of evolution of otology as a whole, the goal
for each surgeon is to eradicate underlying disease and provide a functional hearing to
the patient as far as practicable. The question is still on how to devise a method so as
to give maximum postoperative hearing using minimal instrumentation (1,2).In 1878; Emil
Berthold was the first to describe the surgical procedure of myringoplasty, using a
free skin graft from the forearm (3). For surgical treatment of TM perforations use of
autologous auto grafts including, muscle fascia or perichondrium is reported in most
studies with a success rate between 88% and 97%. However, surgical treatment
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requires higher costs, more effort and surgical risks. Therefore, many investigators
have studied topical use of substances to facilitate TM repair and alternative methods
to the surgical repair of TM perforations (4).Estrogen can influence the various phases
of wound healing in cutaneous repair, in the inflammatory phase neutrophils are the
first cells to arrive at the wound site in significant numbers (1). Estrogen regulates the
synthesis of Interleukine-1 (IL-1) and platelet-derived growth factor (PDGF) by
macrophages and may have an indirect effect on the proliferative phase. IL-1
stimulates hyaluronic acid synthesis and collagen deposition while PDGF stimulates
angiogenesis.It also influences the matrix formation and remodeling phase and
increase the tensile strength of the wound (1).Topical estrogen application may
influence the repair of TM perforations. This study was performed to investigate the
effects of estrogen – impinged paper patch on healing of chronic TM perforations and
compares it with simple paper patch in a double-blinded clinical trial.
Aims and Objectives: The aim of the work was to study the effect of topical
estrogen on healing of chronic tympanic membrane perforations as an office
procedure for myringoplasty .
Patients and methods: It is an office procedure done upon the period from
November 2013 to November 2014 at E.N.T. department, Benha faculty of medicine.
Inclusion criteria: Presence of central perforation for more than 3 months, Unilateral
perforation, Perforation size less than 40% of the total area of the tympanic
membrane, Dry ear for at least 2-3 months preoperative, Air-bone gap less than 30 dB
in the affected ear, Absence of ossicular or mastoid pathology as evidenced in C.T.
scan.
Exclusion criteria: Perforation size greater than 40% of the total area of the TM,
Presence of cholesteatoma or granulation tissue or polyp in The middle ear, Presence
of otorrhea in the past 3 months, Presence of marginal perforation or recent
perforation of the TM, Infected external auditory canal, Previously operated ear, nonfunctioning Eustachian tube.
Every patient in this study was submitted for: Informed consent taken from the
patient, complete history taking, General examination, Full ENT examination and
pure tone audiometry.
The office procedure was done by same E.N.T. surgeon as follows:
Patients were randomly allocated into two groups of 15 each.. Under vision of an
operating microscope, local anesthesia was administered using 10% lidocaine spray
applied inside the external auditory canal ,The margin of the perforation was
refreshed with a sharp curved needle to create afresh edge, Using a crocodile forceps,
Patches were placed, and spread over the perforation using a straight blunt ended
needle as shown in figure (1), Paper patch should be more than one and half the size
of perforation, Filling the external ear canal with gel foam to stabilize the patch,
Packing external ear slightly with small sterile gauze soaked in tetracycline ointment,
Placing sterile gauze and adhesive plaster over the auricle, Medications include
antibiotic ear drops three times per day( we used cipro ear drops), prophylactic
antibiotic, antihistaminic, Patient is instructed to keep water out of the ear and notify
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if any discharge occurs. The procedure is nearly painless and should take 15 minutes
or less. The patient returns to the office week later for removal of aural pack, Stop
medical treatment, and weakly examination of the ear under microscope.
After two weeks suction of gel foam, then at end of one month after the procedure,
take a photo for tympanic membrane for assessing size of perforation as shown in
figure (2) and complete closure detected as shown in figure(3) . Pure tone audiogram
had been done after one month of the procedure as shown in figure (4,5,6,7).
Figure(1) Paper patch in place over perforation.
Figure(2)Image obtained through circumscription of the tympanic membrane and of
its perforation.(The selected image were evaluated by circumscribing (by tracking
with a mouse) the total area of the tympanic membrane, which was then measured by
pixel counting, the same procedure was applied to the area of the perforation. Both
measures were transported to an Excel® (Microsoft office 2007) spreadsheet).
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Figure(3)Perforation at 4th week (Healed tympanic membrane)
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Figure(4):Case A: pre procedure pure tone audiogram (PTA) showing ABG 15 dB.
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Figure(5):Case A; at the end of one month after procedure PTA showing normal ABG
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