Non-Surgical Methods for Promoting Neovascularization of Tympanic Membrane Perforations
The most effective non-surgical method for promoting neovascularization of tympanic membrane perforations is the application of basic fibroblast growth factor (b-FGF) with a gelatin sponge scaffold, which has demonstrated closure rates of up to 98.1% in clinical trials. 1
Growth Factor Applications
- Basic fibroblast growth factor (b-FGF) applied with a gelatin sponge scaffold following freshening of the perforation edge has shown significantly higher closure rates (98.1%) compared to control treatments (10%) with no reported adverse events 1
- Tissue-engineered myringoplasty using biomolecules to stimulate growth of perforation edges has demonstrated promising results in multiple studies 1
- Platelet-derived growth factor (PDGF) has been studied but showed limited efficacy in clinical trials, with one randomized controlled trial finding only a small effect (-2%) compared to placebo 2
- Platelet releasate has not shown statistical difference in perforation closure rates compared to controls in animal models, though it did consistently produce a thicker fibrous layer histologically 3
Bioengineered Scaffolds
- Poly(glycerol sebacate) (PGS) plugs have demonstrated effective repair with neovascularization in animal models, with 10 out of 11 perforations healing at six weeks 4
- Three-dimensional porous collagen scaffolds combined with topical umbilical cord serum achieved 100% closure of chronic tympanic membrane perforations in animal studies, compared to 43% in control groups 5
- Various scaffold materials have been tested and found to be safe, with improved tympanic membrane perforation healing rates 1
- Epifilm has shown superior healing properties with less fibrosis and minimal neovascularization compared to other materials in animal studies 6
Topical Treatments
- Topical therapy with non-ototoxic preparations is essential when treating perforations to prevent ototoxicity 7
- Ofloxacin is specifically recommended for ear infections in patients with known or suspected tympanic membrane perforation as it is non-ototoxic 7
- Avoiding potentially ototoxic preparations is critical when treating ear infections in patients with perforated tympanic membranes 7
Preventive Measures During Healing
- Keeping the ear dry is essential to prevent infections that may impede healing 8, 9
- Avoiding ear irrigation and pneumatic otoscopy in cases of suspected or confirmed perforation is important to prevent further damage 8, 9
- Using only non-ototoxic topical preparations when the tympanic membrane is not intact is crucial for successful healing 7, 9
Considerations for Specific Patient Groups
- Patients with diabetes require special attention as they are at higher risk for complications from ear procedures 8
- Patients with a history of ear surgery or atrophic areas of the tympanic membrane have increased risk of complications and may require more careful management 8
- Immunocompromised patients may need more aggressive treatment approaches due to higher risk of infection 8
Monitoring and Follow-up
- Reevaluation is necessary if symptoms do not resolve completely after 2 weeks of initiated treatment 9
- Persistent perforations may require surgical closure through myringoplasty or tympanoplasty if non-surgical methods fail 9
- There may be a slight worsening (1-2 dB) in hearing thresholds after healing, though this is generally not clinically significant 9
Emerging Approaches
- Ongoing research on trans-tympanic delivery of drugs without requiring a tympanic membrane perforation or tube shows promise 1
- Novel adjuvant treatments including biomolecules and bioengineered scaffolds continue to be developed and tested 1
- Future research should focus on establishing which methods of application are most practical and effective in humans 1