Effect of esterified hyaluronic acid as middle ear packing in tympanoplasty for adhesive otitis media

Abstract

Objectives: The goal of this study was to evaluate the effects of middle ear packing agents (MEPA) on post-operative hearing improvement and complications after tympanoplasty in patients with adhesive otitis media (OM).

Materials and methods: Patients with adhesive OM who underwent tympanoplasty surgery were enrolled in the study between January 2012 and January 2015. A total of 205 patients who received canal wall-down tympanoplasty with ossicular chain reconstruction were randomized into one of the three groups with different MEPA. Group 1 (n = 72) received MeroGel as the MEPA, Group 2 (n = 64) cartilage, and Group 3 (n = 69) both. Air conduction (AC) and bone conduction (BC) thresholds at 0.5, 1, 2, and 4 kHz were measured, and air-bone gaps (ABG) were analyzed before and after the surgery for each patient.

Results: Mean pre- and post-operative ABG was 30.9 dB and 17.6 dB in Group 1, 31.4 dB and 21.9 dB in Group 2, and 32.2 dB and 19.1 dB in Group 3. The ABG closure was 13.3 ± 7.5 in Group 1, 9.5 ± 5.9 in Group 2, and 13.1 ± 9.3 in Group 3. The improvement of ABG after surgery was statistically significant in all three groups (p < .05). The ABG closure was statistically significantly smaller in Group 2 than in other two groups (p < .05).

Conclusions: Tympanoplasty using esterified hyaluronic acid (i.e. MeroGel) or cartilage as the MEPA resulted in improved hearing for patients with conductive hearing loss due to adhesive OM. Using MeroGel as the MEPA appeared to achieve a better post-operative outcome than using cartilage.

Chinese abstract

目的：本研究的目的是评估中耳包封剂（MEPA）对粘连性中耳炎（OM）患者在鼓膜成形术后的听力改善和术后并发症的影响。

材料与方法：2012年1月至2015年1月研究期间, 招募了接受鼓室成形术的粘连性中耳炎患者。共205例接受管壁下鼓室成形术并听小骨链重建的患者, 随机分为三组, 具有不同的 MEPA。组1（n = 72）接受了用作MEPA的MeroGel；组2（n = 64）用软骨；组3（n = 69）两种都用。测量了在0.5、1、2和4kHz的空气传导（AC）和骨传导（BC）阈值, 并且在每个患者的手术前、后分析空气 - 骨隙（ABG）。

结果：组1, 术前和术后平均ABG分别为30.9分贝和17.6分贝；组2, 分别为31.4分贝和21.9分；组3, 分别为32.2分贝和19.1分贝。组1中ABG闭合率为13.3 ± 7.5；组2中为9.5 ± 5.9；组3为13.1 ± 9.3。手术后ABG的改善在所有三组中均有统计学意义（p < 0.05）。组2中的ABG闭合在统计学上显著小于其他两组（p < 0.05）。

结论：使用酯化透明质酸（即MeroGel）或软骨作为MEPA的鼓室成形术导致由于粘连性OM引起的导电性听力损失患者的听力改善。使用MeroGel作为MEPA似乎取得了比使用软骨更好的术后结果.

Keywords:

• Adhesive otitis media
• cartilage
• esterified hyaluronic acid
• MeroGel
• tympanoplasty

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was funded in part by the Youth Science Fund Project of China (81300818), the National Nature Science Foundation of China (81371087), Shanghai Science and Technology Commission Medical Guide Project (134119a1800), Nature Science Foundation of Jiangsu Province for Young Scholar (#BK20160344), Nature Science Foundation of Jiangsu Province for Colleges and Universities (#16KJB320011), National Nature Science Foundation of China (#81600796), Joint project of key disease of health system in shanghai (2014ZYJB0005).