Studies on tympanic membrane transplants. I. Tympanic homografts.
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Alcohols↗
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Capillary hemangioma of the tympanic membrane.
Hemangiomas of the tympanic membrane are extremely rare. We present the third reported case and, to our knowledge, the first capillary hemangioma of the tympanic membrane. These deep purple polypoid tumors are asymptomatic while small but enlarge slowly to erode adjacent structures. They arise characteristically from the lamina propria of the tympanic membrane without involving the middle ear. Early recognition permits simple excision with preservation of the lamina propria, avoiding the need for tympanic membrane resection and reconstruction.
Ear Neoplasms↗
The homograft myringoplasty and the lamina propria of the tympanic membrane.
The lamina propria of the tympanic membrane is composed of a unique system of radial and nonradial fibers which contribute importantly to its function. Over 1000 patients have undergone operations for the transplantation of the homograft tympanic membrane. Animal experiments have been presented to determine whether or not the fiber system of the lamina propria of the tympanic membrane is preserved in the homograft tympanic membrane. In conjunction with this, a small series of experiments was conducted to determine the appearance of the fiber system in perforations that heal spontaneously. Current knowledge concerning the function of the fiber network is discussed. The results of the present study indicate that the lamina propria fiber network is at least partially preserved in the homograft tympanic membrane and that the fiber network of the lamina propria is not reconstituted in spontaneously healed tympanic membranes.
Animals↗
Iontophoretic anaesthesia of the tympanic membrane.
Anaesthesia of the tympanic membrane by iontophoresis of lidocaine is a painless and safe method for myringotomy and grommet insertion. Thirty-nine patients with serous otitis media and 11 patients with Ménière's disease had their tympanic membranes anaesthetized by iontophoresis of lidocaine; analgesia was perfect for all of them. In the patients with serous otitis media, the insertion of grommets was carried out easily and without pain. Major problems or complications have not been encountered during this study.
Adolescent↗
Homograft replacement of the tympanic membrane.
This paper presents the authors' experiences with one method of reconstruction of the tympanic membrane when it is totally absent or when there is a fixed, retracted, defective, or absent malleus. Ten patients undergoing surgery for chronic suppurative otitis media between April, 1971, and January, 1973, had homograft tympanic membranes and/or ossicles used to reconstruct the defect in the tympanic membrane or ossicular mechanism. The patients had certain clinical and surgical characteristics in common: 1. all had either an absent tympanic membrane or almost total perforation of it; 2. all were operated upon in the absence of acute infection or active drainage; cholesteatoma, if present, was totally removed; 3. all had patent eustachian tubes; 4. all had intact middle ear mucosa at the time of utilization of the homograft; 5. all patients were operated upon by the same surgeon; 6. all of the homografts were obtained within 24 hours and were used within one month after the death of the donor; 7. all of the homografts used had been preserved in 70 percent ethyl alcohol; 8. all of the homograft materials came from donors who were under 40 years of age at the time of death and who died of accidental causes. (None of the donors was known to have any pre-existing disease); 9. all homografts, after being placed in proper position in the recipient, were covered with ear canal skin; 10. all patients received homografts that were from the corresponding ear of the donor. (In other words, right ear homografts were used in the patient's right ear, etc.); 11. whenever the tympanic ring was greater than the size of the homograft, the patient's temporalis fascia was used in conjunction with the homograft tympanic membrane to bridge the defect; 12. all patients had the middle ear packed with gelfoam prior to inserting the homograft (compressed gelfoam was used also for the outer packing); 13. none of the patients had tissue-typing procedures carried out in an effort to match the donor and the recipient, nor was any attempt made to match the sex of the donor and the recipient; and 14. all patients received antibiotics postoperatively; however, none received immunosuppressive therapy postoperatively. In 3 of 10 patients receiving homografts, the malleus was normal, and only the tympanic membrane was reconstructed. In seven others there was a fixed, retracted, defective or absent malleus in addition to the tympanic membrane defect.(ABSTRACT TRUNCATED AT 400 WORDS)
Adult↗
Ultrastructure of fibrils in developing human and guinea-pig tympanic membrane.
The development of connective tissue of the tympanic membrane has been examined in guinea-pig embryos and fetuses from 22 days of gestation (10 mm CR length) to birth (at about 67 days, 100 mm), in neonatal animals for the first 3 weeks of life, and in human embryos and fetuses aged 6, 11, 15 and 22 weeks. In the guinea-pig up to 34 days of gestation there was little evidence of fibril formation, but from 37 days onwards fibrils were an obvious feature of the tympanic membrane area. When first observed they resembled small collagen fibrils but there was no cross-banding, and within a week to 10 days they showed the foursubunit configuration typical of adult tympanic membrane fibrils in this species. There was no increase in fibril diameter and elastic fibres were not seen. In the human fetuses small groups of collagen fibrils (already of larger diameter than guinea-pig fibrils) were apparent at 11 weeks, together with small groups of elastic microfibrils. Later specimens showed increasing numbers of cross-banded collagen fibrils and the development of the amorphous elastin component in association with the microfibrils.
Animals↗
Temporal bone histopathology in chronically infected ears with intact and perforated tympanic membranes.
Chronic suppurative otitis media has been clinically defined as a chronic discharge from the middle ear in the presence of a perforation of the tympanic membrane. However, irreversible tissue pathology in the middle ear or mastoid can occur behind an intact tympanic membrane. One hundred forty-four human temporal bones with chronic otitis media were divided into two groups: those with perforated (28) and those with nonperforated (116) tympanic membranes. The histopathological findings of their middle ears were compared. Granulation tissue in various degrees was the most prominent pathological feature. It was observed in 96% of temporal bones with perforation of the tympanic membrane, and in 97% of those without perforation. Also found were ossicular bony changes (96% with perforation; 90.5% without), middle ear effusion (93% with perforation; 89% without), cholesterol granuloma (21% with perforation; 12% without), cholesteatoma (36% with perforation; 4% without), and tympanosclerosis (43% with perforation; 20% without). This study shows that the histopathological changes of the middle ear are similar in temporal bones with and without perforation of the tympanic membrane. The clinician should, therefore, be aware that an intact tympanic membrane does not necessarily preclude the presence of gross pathological changes of the middle ear cleft.
Adolescent↗
Symposium: Methods of reconstruction in tympanoplasty. II. Maintenance of the anterior sulcus-tympanic membrane relationships in tympanoplastic surgery.
A technique for closure of tympanic membrane perforation which preserves the normal anterior sulcus-tympanic membrane relationships is described. This underlay fixation technique provides a high graft take, good conization of the drum, prevention of lateralization of the reconstructed drum and elimination of tenting or blunting of the anterior sulcus. The reconstructed tympanic membrane presents a near normal appearance with good physiological and acoustic properties.
Fascia↗
Electron microscopic observations on the repair of perforated tympanic membranes in the guinea-pig.
Experimental perforations of the tympanic membrane in the guinea-pig have been examined electron microscopically. The perforation site became filled with maturing granulation tissue, covered on its external (meatal) and internal (middle ear) surfaces by cells derived from the epithelia of the respective surfaces of the normal membrane. The fibrils and interfibrillar matrix of the normal tympanic membrane in this species have a unique ultrastructure. The fibrils are quadrangular, apparently composed of four subunits, and the surrounding matrix is more electron-dense than in most connective tissues. During repair this type of fibril and matrix was not reconstituted within the 6 month period examined. In its place were formed fibrils of varying diameter, probably collagenous, and differing from those of normal membrane both in size and in the lack of characteristic interfibrillar matrix. The fibroblasts of the wound site, even if of local origin, thus do not appear to be capable of synthesizing the local type of connective tissue.
Animals↗
Volume displacement of the tympanic membrane at stapedius reflex activity in different postures. Studies on variations in perilymphatic pressure.
With the microflow method the volume displacement of the tympanic membrane and its direction of movement can be recorded at stapedius reflex contraction. There is an outward or inward movement of the tympanic membrane, which is affected by changes in posture. The results indicate that the perilymphatic pressure in man varies with the posture and that these variations can be measured indirectly outside the tympanic membrane. This can only be done, however, on condition that there are no pressure variations across the tympanic membrane. This method opens up new ways of studying possible pressure changes in the inner ear in acute diseases.
Auditory Threshold↗
Volume displacement of the tympanic membrane in the sitting position as a function of middle ear muscle activity. A quantitative microflow method.
An open microflow meter system has been worked out for quantitative recording of the volume displacement of the tympanic membrane and its movement direction at stapedius reflex. An acoustically elicited M. stapedius contraction can be recognized by the characteristic response and latency time. The stapedius reflex contraction causes an outward or inward movement of the tympanic membrane. The magnitude of the volume displacement of the tympanic membrane is influenced by the middle ear pressure and in some ears the movement direction of the tympanic membrane changes.
Adult↗
Air caloric stimulation with tympanic membrane perforation.
Warm air caloric stimulation in an ear with tympanic membrane perforation or mastoidectomy cavity often causes contralateral nystagmus. Secondary nystagmus is common. Our evidence with squirrel monkeys and patients indicates that the primary "inversion" results from endolymph cooling due to evaporative cooling due to evaporative cooling of the mucus lining the middle ear cavity, by the dry air stimulus. Disconjugate horizontal nystagmus was found in a patient with large eardrum perforation, after cold air caloric stimulation. The effect probably resulted from stimulation of the anterior or posterior vertical semicircular canal. Inverted or disconjugate caloric nystagmus after air stimulation is much more frequently due to tympanic membrane perforation, or moisture in the external ear, than to central nervous system disease.
Air↗
Human tympanic membrane--malleus attachment. Preliminary study.
The relationship between the malleus handle and the tympanic membrane in humans has been studied with primary attention being directed to the fibrous layer of the tympanic membrane and its method of attachment to the malleus. This attachment is most intimate at the level of the umbo and becomes progressively more tenuous as the short process is approached. The long process of the malleus, comprised of a bony core, has a definite sleeve of cartilage surrounding its entire length. This cartilage is surrounded by a perichondrial layer which has previously been termed a periosteum. In the lower third, the fibrous lamina propria appears to split equally and the fibers then blend imperceptively with those of the perichondrial layer surrounding the manubrium. At high levels, the attachment is less intimate, most of the fibers appearing to pass lateral to the malleus handle. The embryologic development of the tympanic membrane-malleus junction has been considered and the anatomical features of this area have been considered in relation to functional requirements.
Ear Ossicles↗
[Closure of recurrent perforations of the tympanic membrane (author's transl)].
In 20 patients with recurrent perforations of the tympanic membrane after tympanoplasty, closure was attempted with a fibrin tissue adhesive and in 15 this was successful. This method is recommended for the office out-patient treatment of recurrent tympanic membrane perforations.
Fibrin↗
Biological considerations for the use of homograft tympanic membranes and ossicles.
This report deals with some biological aspects of transplantation and preservation of tympanic membrane and ossicular grafts. The structure and behaviour of tympanic membrane grafts depends largely on the reaction of the preservatives with the tissue proteins. Due to these properties no observable change in the microscopical structure of the membranes and ossicles was found up to 3 years after alcohol and formaldehyde preservation. Preservation in cialit showed gradual disappearance of nuclei and an increasing disintegration of the fibrous structures. Irrespective of the mode of preservation, the fibrous tissue appeared to persist virtually unaffected for long periods. The monocellular reaction found around the grafts preserved in formaldehyde after heterolopie transplantation suggests that tissue antigens are not completely destroyed. A reaction to transplantation in the middle ear is only found around fresh heterologous grafts and around the fresh homologous grafts after previous sensitisation. As observed in rats, ossicles preserved in alcohol or cialit, obtained from revision operations in humans showed partial remodelling. Moreover in some cases these ossicular and especially the cartilaginous grafts showed areas of frank erosion.
Animals↗
[Comparison of 2 materials in the reconstruction of the tympanic membrane. Our experience in 300 patients].
The authors evaluated the results obtained from the tympanic membrane reconstruction in 300 patients affected by simple, purulent or cholesteatomatous chronic middle ear otitis. In this tympanic membrane reconstruction they used: jugular vein strip of a calf and temporal muscle fascia in 150 cases. On pathological basis (simple, purulent and cholestéatomatous otitis) they used the overlay or the underlay method. In 5 years that follows, the materials (vein and fascia), if properly used, would give similar results. For such reasons the authors proposed: temporal muscle fascia autotransplantation with underlay method in partial myringoplasty; heterotransplantation of modelled jugular vein strip with overlay method in subtotal or total myringoplasty.
Fascia↗
Early repair of blast ruptures of the tympanic membrane.
A method and results of early repair of blast rupture of the tympanic membrane in 24 selected cases, where flaps and/or free edges of the torn eardrum could be detected by examination with the operating microscope, are presented. By reversion of the flaps and approximation of the edges, the perforation was closed or significantly diminished. This ensured the healing of the tympanic membrane in all cases within days instead of months. No complications were noted during a subsequent two to three-years' follow-up. The improved hearing was stable.
Adolescent↗
Antigenicity of the guinea pig's tympanic membrane.
The immunogenicity of the middle ear constituents is a matter of prime importance. In this work, the authors were interested in the antigenicity of the guinea pig's tymphanic membrane. They reached the conclusion, after developing an antiserum (IgG), that the tympanic membrane of the guinea pig can be antigenic in the rabbit. After purification and absorption, a cross-reactivity remains between the tympanic membrane and the mucosae of the upper respiratory system.
Animals↗