Braz. j. . vol.82 número5

BrazJOtorhinolaryngol.2016;82(5):618---619

www.bjorl.org

Brazilian

Journal

of

OTORHINOLARYNGOLOGY

LETTER

TO

THE

EDITOR

Treatment

of

tympanic

membrane

perforation

using

bacterial

cellulose:

a

randomized

controlled

trial

Tratamento

de

perfurac

¸ão

da

membrana

timpânica

com

uso

de

celulose

bacteriana:

estudo

controlado

randomizado

DearEditor,

Herein, we present a review of the manuscript titled ‘‘Treatmentoftympanicmembraneperforationusing bac-terialcellulose:Arandomizedcontrolledtrial’’bySilveira etal.1

The work outlined in this manuscript was interesting. Afterreview,weagreewiththeauthorsthatbacterial cel-luloseisanexcellentmaterialfortympanicmembrane(TM) regeneration andmay bean effective alternative to con-ventionalmyringoplasty.However,webelievethefollowing detailsofthisstudyshouldbefurtherclarified:

The size of the perforation: Although the authors reported a 100% closure rate using bacterial cellulose in 14smallchronicTMperforations,theycalculatedthisrate by categorizing the size of the perforation as small or medium.However,theydidnotclearlydescribethe perfo-rationdiameterasameasurement(i.e.,inmillimetersoras apercentageoftheTM).Previouslypublishedstudies indi-catethattheuseofGelfoamorpaperpatchtympanoplasty onsmallchronicTMperforationsiseffective.Anders Niklas-sonetal.2 _{reportedthat Gelfoamplugmyringoplasty was}

successfulfor12smallchronicTMperforations,2---4mmin size.AnotherstudybyParketal.3_{reportedaclosurerateof}

78.3%usingcigarettepaperon23chronicTMperforations, lessthan5%oftheTMinsize.Similarly,Golzetal.4_reported

a78.3%closurerateusingcigarettepaperin38chronicTM perforations,lessthan3mminsize.Itisalsoimportantto notethatGelfoamandcigarettepaperareconvenient,easy touse,andinexpensivecomparedtobacterialcellulose.

夽 _{Pleasecitethisarticleas:LouZ.Treatmentoftympanic}

mem-braneperforationusingbacterialcellulose:arandomizedcontrolled trial.BrazJOtorhinolaryngol.2016;82:618---9.

The inclusion criteria are vague: For the inclusion criteria, the authors stated, ‘‘40 patients with tympanic membrane perforations caused by otitis media were enrolled in a randomized controlled clinical study... Patients with marginal, damp or cholesteatoma perfora-tionswereexcluded.’’Therewasnoindicationofwhether perforations with sclerotic plaques were included in this study. Sclerotic plaques are the primary factor affecting thesuccessrateofmyringoplasty.Somestudiesevaluating theuseoftympanoplastytotreatchronicTMPsfoundthat excision ofscleroticplaquesimproved thesuccessrate.5,6

Resultsfromtwostudiesutilizingfibroblastgrowthfactor-2 (FGF-2) for the treatment of traumatic andchronic TMPs indicated that residual TM calcification was a significant risk factor for nonhealing.7,8 _{Similarly, the results from a}

studyinvestigatingalargesampleofspontaneouslyhealing traumatic TMPs showed that preexistingsclerotic plaques weretheprimarycauseofnonhealing.9

Thetherewasnodetaileddescription ofmanagement of the perforated edge:For the experimental group, the authors stated, ‘‘The perforated edges were scarified, andthen abacterialcellulose membranewasplacedover the perforation laterally to the tympanic remains. The membrane was held in place by self-adhesion.’’ During myringoplasty, in the majority of cases, perforatededges areexcisedtocreateafreshedgeforthepatchortemporal fasciagraftofthechronicTMP.

To effectively convey the methodology utilizedin this study,we believe thatthe authorswill need toelaborate onallthreeoftheabove-mentionedpoints.

Conflicts

of

interest

Theauthordeclaresnoconflictsofinterest.

References

1.SilveiraFC,PintoFC,CaldasNetoSD,LealMC,CesárioJ,Aguiar JL.Treatmentoftympanicmembraneperforationusingbacterial cellulose:arandomizedcontrolledtrial.BrazJOtorhinolaryngol. 2015.S1808-8694(15)00136-6.

2.NiklassonA,TanoK.TheGelfoam®_{plug:analternativetreatment} forsmalleardrumperforations.Laryngoscope.2011;121:782---4. 3.ParkSN,Kim HM,JinKS,MaengJH, Yeo SW,Park SY. Predic-torsforoutcomeofpaperpatchmyringoplastyinpatientswith

http://dx.doi.org/10.1016/j.bjorl.2016.05.002

LETTERTOTHEEDITOR 619

chronic tympanic membrane perforations. EurArch Otorhino-laryngol.2015;272:297---301.

4.GolzA,GoldenbergD,NetzerA,FradisM,WestermanST, West-ermanLM,etal.Paperpatchingforchronictympanicmembrane perforations.OtolaryngolHeadNeckSurg.2003;128:565---70. 5.Migirov L, Volkov A. Influence of coexisting

myringosclero-sis on myringoplasty outcomes in children. J Laryngol Otol. 2009;123:969---72.

6.Aslan H, Katilmis¸H, Oztürkcan S, Ilknur AE,Bas¸o˘glu S. Tym-panosclerosisandoursurgicalresults.EurArchOtorhinolaryngol. 2010;267:673---7.

7.HakubaN,HatoN,OkadaM,MiseK,GyoK.Preoperativefactors affectingtympanicmembraneregenerationtherapyusingan ate-locollagenandbasicfibroblastgrowthfactor.JAMAOtolaryngol HeadNeckSurg.2015;141:60---6.

8.Lou Z, Yang J, Tang Y, Xiao J. Risk factors affecting human traumatic tympanic membrane perforation regeneration ther-apyusingfibroblastgrowthfactor-2.Growth Factors.2015;18: 1---9.

9.LouZC,TangYM,YangJ.Aprospectivestudyevaluating spon-taneous healing of aetiology, size, and type-different groups oftraumatictympanicmembraneperforation.ClinOtolaryngol. 2011;36:450---60.

ZhengcaiLou

DepartmentofOtorhinolaryngology,TheAffiliatedYiWu HospitalofWenzhouMedicalUniversity,Zhejiang322000, China