Skip to main content

Effect of topical use of platelet-rich fibrin in repairing central tympanic membrane perforation using the endoscopic inlay butterfly cartilage myringoplasty technique

Abstract

Objective

The aim of this study was to determine the effectiveness of inlay butterfly cartilage myringoplasty and to assess the importance of topical use of autologous platelet-rich fibrin (PRF) in this technique.

Patients and methods

Fifty patients with dry central perforation were classified into two groups: group A included 25 patients who had undergone endoscopic inlay butterfly myringoplasty with the use of autologous PRF, and group B consisted of 25 patients who had undergone the same technique but without the use of autologous PRF. The study was performed during the period between 2013 and 2016. The follow-up period ranged from 1 to 14 months. All patients were assessed clinically to evaluate healing of tympanic membrane, postoperative air-bone gap, and complications.

Results

The overall graft take rate was 96% (24 cases) in group A, whereas the graft take rate in group B was 76% (19 cases) with a statistically significant difference between the two groups. The hearing results were satisfactory and compatible with previous studies in the literature. No postoperative complications were reported.

Conclusion

Inlay butterfly cartilage myringoplasty is a simple technique for repairing small-to-medium-sized tympanic membrane perforation. The success rate of this technique has improved with topical application of PRF. The autologous PRF not only enhances healing of the graft but also protects it from infection.

References

  1. 1

    Gross C, Bassila M, Lazar R, Long T, Stagner S. Adipose plug myringoplasty: an alternative to formal myringoplasty techniques in children. Otolaryngol Head Neck Surg. 1989; 101:617–620.

    CAS  Article  Google Scholar 

  2. 2

    Kartush JM. Tympanic membrane Patcher: a new device to close tympanic membrane perforations in an office setting. Am J Otol 2000; 21:615–620.

    CAS  PubMed  Google Scholar 

  3. 3

    Yung M. Cartilage tympanoplasty: literature review. J Laryngol Otol. 2008; 122:663–672.

    CAS  Article  Google Scholar 

  4. 4

    Ghanem MA, Monroy A, Alizade FS, Nicolau Y, Eavey RD. Butterfly cartilage graft inlay tympanoplasty for large perforations. Laryngoscope 2006; 116:1813–1816.

    Article  Google Scholar 

  5. 5

    Eavey RD. Inlay tympanoplasty: cartilage butterfly technique. Laryngoscope 1998; 108:657–661.

    CAS  Article  Google Scholar 

  6. 6

    Choukroun J, Adda F, Schoeffler C, Vervelle A. The opportunity in perio-implantology: The PRF. Implantodontie 2001; 42:55–62.

    Google Scholar 

  7. 7

    Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J, et al. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part I: technological concepts and evolution. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 101:e37–e44.

    PubMed  Google Scholar 

  8. 8

    Saliba I. Hyaluronic acid fat graft myringoplasty: how we do it. Clin Otolaryngol 2008; 33:610–614.

    CAS  Article  Google Scholar 

  9. 9

    Sergi B, Galli J, De Corso E, Parrilla C, Paludetti G. Overlay versus underlay myringoplasty: report of outcomes considering closure of perforation and hearing function. Acta Otorhinolaryngol Ital 2011; 31:366–371.

    CAS  PubMed  PubMed Central  Google Scholar 

  10. 10

    Yu MS, Yoon TH. Bilateral same-day surgery for bilateral perforated chronic otitis media: inlay butterfly cartilage myringoplasty. Otolaryngol Head Neck Surg 2010; 143:669–672.

    Article  Google Scholar 

  11. 11

    Lubianca-Neto JF. Inlay butterfly cartilage tympanoplasty (Eavey technique) modified for adults. Otolaryngol Head Neck Surg 2000; 123:492–494.

    CAS  Article  Google Scholar 

  12. 12

    Mauri M, Lubianca-Neto JF, Fuchs SC. Evaluation of inlay butterfly cartilage tympanoplasty: a randomized clinical trial. Laryngoscope 2001; 111:1479–1485.

    CAS  Article  Google Scholar 

  13. 13

    Couloigner V, Baculard F, El Bakkouri W, Viala P, François M, Narcy P, et al. Inlay butterfly cartilage tympanoplasty in children. Otol Neurotol 2005; 26:247–251.

    Article  Google Scholar 

  14. 14

    Omran AA. Endoscopic bivalve inlay cartilage myringoplasty for central perforations: preliminary report. Egypt J Ear Nose Throat Allied Sci 2012; 13:37–42.

    Article  Google Scholar 

  15. 15

    Effat KG. Results of inlay cartilage myringoplasty in terms of closure of central tympanic membrane perforations. J Laryngol Otol 2005; 119:611–613.

    Article  Google Scholar 

  16. 16

    Ross R, Glomset J, Kariya B, Harker L. A platelet-dependent serum factor that stimulates the proliferation of arterial smooth muscle cells in vitro. Proc Natl Acad Sci USA 1974; 71:1207–1210.

    CAS  Article  Google Scholar 

  17. 17

    Erkilet E, Koyuncu M, Atmaca S, Yarim M. Platelet-rich plasma improves healing of tympanic membrane perforations: experimental study. J Laryngol Otol 2009; 123:482–487.

    CAS  Article  Google Scholar 

  18. 18

    El-Anwar MW, El-Ahl MA, Zidan AA, Yacoup MA. Topical use of autologous platelet rich plasma in myringoplasty. Auris Nasus Larynx 2015; 42:365–368.

    Article  Google Scholar 

  19. 19

    Gur OE, Ensari N, Ozturk MT, Boztepe OF, Gun T, Selcuk OT, et al. Use of a platelet-rich fibrin membrane to repair traumatic tympanic membrane perforations: a comparative study. Acta Otolaryngol 2016; 136:1017–1023.

    CAS  Article  Google Scholar 

  20. 20

    Dornhoffer JL. Hearing results with cartilage tympanoplasty. Laryngoscope 1997; 107:1094–1099.

    CAS  Article  Google Scholar 

  21. 21

    Everts PA, Knape JT, Weibrich G, Schonberger J, Hoffmann J, Overdevest EP, et al. Platelet-rich plasma and platelet gel: a review. J Extra Corpor Technol 2006; 38:174–187.

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Mohamed Hosam.

Additional information

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Hosam, M., Shaker, M. & Aboulwafa, A. Effect of topical use of platelet-rich fibrin in repairing central tympanic membrane perforation using the endoscopic inlay butterfly cartilage myringoplasty technique. Egypt J Otolaryngol 33, 557–563 (2017). https://doi.org/10.4103/ejo.ejo_7_17

Download citation

Keywords

  • cartilage
  • inlay butterfly
  • myringoplasty
  • platelet-rich fibrin