Safety and efficacy of topical mitomycin C in myringotomy patency

Safety and efficacy of topical mitomycin C in myringotomy patency,10.1067/mhn.2001.114255,Otolaryngology-head and Neck Surgery,David Jassir,Craig A. B

Safety and efficacy of topical mitomycin C in myringotomy patency   (Citations: 27)
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Objective: To develop an alternative method for prolonged middle ear ventilation using topical mitomycin C. Study Design and Setting: Twenty guinea pigs with normal ears had bilateral myringotomies performed using the argon laser. After myringotomy, either mitomycin C (0.4 mg/mL) or saline pledgets were applied topically. Monitoring consisted of otomicroscopy and distortion-product otoacoustic emissions. Results: Before myringotomy, all tympanic membranes were intact, and distortion-product otoacoustic emissions were measurable. After myringotomy, none (0%) of the saline-treated myringotomies were patent at day 7 as compared with 100% of the mitomycin C-treated myringotomies. At day 42, 10 (52.6%) of 19 mitomycin-treated myringotomies remained patent and 4 (28.6%) of 14 were patent at 131 days. Five (13.1%) ears developed purulent otorrhea; 3 were mitomycin C-treated and 2 were treated with saline solution.- Distortion-product otoacoustic emissions testing did not document any evidence of ototoxicity. Conclusion: Topical mitomycin C appears to be safe and effective at prolonging the duration of myringotomy patency in the guinea pig. Significance: Mitomycin C may be useful as an adjunct for preventing myringotomy closure. (Otolaryngol Head Neck Surg 2001;124:368-73.)
Journal: Otolaryngology-head and Neck Surgery - OTOLARYNGOL HEAD NECK SURG , vol. 124, no. 4, pp. 368-373, 2001
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    • ... and thus not appropriate to otoendoscopic procedures and those who had a wide ear canal (>4 mm in diameter) but refused to receive any further treatments.Methods. They were prescribed oral antibiotics for the duration of 1 week and were asked to keep their ears totally dry.Inclusion Criteria of EGF-Containing Gelatin Sponge PatchingPatients who had a wide ear canal (>4 mm in diameter), perforation flap(s) ≤1/4 of the total perforation area or a perforation which had happened >4 days previously.Methods. Ear wax was cleaned up. The flattened gelatin sponge was wetted with EGF eyedrops as a modification; the flattened gelatin sponge was used in such a manner that it covered the perforated edge. The process was performed using tweezers under a head mirror and also that at least 1 mm of the edge overlapped so that it would not fill the external auditory canal. Moreover, in this procedure, EGF eyedrops were used in the damaged ears once or twice every day so as to keep the gelatin sponge moist.Inclusion Criteria of Eardrum Flap Repair + EGF-Containing Gelatin Sponge PatchingPatients who had a wide ear canal, perforation flap(s) >1/4 of the total perforation area and a perforation which had happened <3 days previously. Methods. Surgery was performed under an ear endoscope using 1% of lidocaine for postauricular local infiltration anesthesia; 2% of bupivacaine was used for tympanic membrane surface anesthesia. Then, blood was aspirated from the external ear canal or the tympanum under a 0- and 90-degree endoscope. Thereafter, the tympanic membrane flap of the perforation edge was wetted using a cotton pellet: this cotton pellet was first dipped in Ringer’s solution. After wetting the eardrum flap, it was then subjected to suction through a microscopic sucker or flipping. Finally, the dislocated eardrum flaps were realigned with a right-angle crochet to restore it to its original position. In this way, the surgeons tried to minimize the damage by alignment. In this surgical procedure, small pieces of wetted gelatin sponge were placed in the tympanum for lining: eardrum flaps were then turned over the gelatin sponge. Eardrum flaps and perforation surface were subsequently attached with a gelatin sponge, which was first wetted with EGF eyedrops before being used in the surgical procedure.Follow-UpAfter treatment, the patients were strictly advised to refrain from pinching and blowing the nose. They were also asked to avoid water penetration into the external auditory canal. After successfully conducting the surgical procedure to treat the perforation, the patients were prescribed oral antibiotics. While studying the recovery of the patients treated with the gelatin sponge patching method and the tympanic membrane flap repair method, we came across a few cases where the patients reported small exudates through the external ear canals. In such cases, the ear canal opening was dried with a damp cotton ball saturated with 75% alcohol: purulent otorrhea was recorded as infected. During the first week after treatment, ear examination was conducted once every day in the 3 groups. In this study, ear endoscopy was used to take photographs, which were used to observe the morphological changes of the tympanic membrane flap and the perforation closure. During the second week, observation was continued in the treated patients who showed satisfactory recovery. On the other hand, the treatment procedure was performed once again if the perforation did not show complete closure. It should be noted that the conservative treatment group was observed once a week, while the other 2 groups were examined once every 3 days. After the third week, each group was examined once a week. At this stage, if the perforation was smaller than 1/8 of the tense tympanic membrane area, the follow-up was continued once every 3 days until 3 months or perforation closure. The major indicator was morphological changes of the tympanic membrane flap. The efficacy of the treatment was assessed using the following parameters: the perforation closure rate and the mean perforation closure time. In pure-tone audiometry, the mean values of 0.5, 1, 2 and 4 kHz air-bone gap were used as hearing parameters. Improvement in the hearing ability of the patients was assessed on the basis of the hearing results: the audiometric tests were conducted 1 week after perforation closure. Because perforations were not monitored on a daily basis, closure observed at a particular monitoring time was assumed to have occurred in the time interval since the previous monitoring [...

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