Using Silk Fibroin Patching to Treat TM Perforation

by Samara E. Kuehne •

Is silk fibroin patching useful in treating patients with chronic tympanic membrane (TM) perforation?

BOTTOM LINE
Silk fibroin patching is a suitable treatment for TM perforation, especially when repairing small perforations. This technique resulted in lower otorrhea, minor complication rates, and high patient satisfaction compared with conventional perichondrium myringoplasty.

Background: Chronic TM perforation is frequently seen in otorhinolaryngologic clinics. Conventional myringoplasty was traditionally recommended to address hearing impairment and ear discomfort and prepare the ear canal for hearing aid placement in patients with mixed hearing loss. However, myringoplasty is relatively expensive and is associated with perioperative patient discomfort and surgery-related morbidities. Recent advances in tissue engineering and biomaterial research have suggested alternative material for TM regeneration. Silk, collagen, chitosan, and calcium alginate have been studied as TM patching materials and have shown favorable results in animal and clinical studies of acute traumatic TM perforation. Among these options, silk fibroin has high biocompatibility and can heal the perforated TM in animal models. Silk fibroin patches (Tympasil; Daewoong-Bio, Seoul, Korea) are thin transparent patches produced from silk fibroin.

Study design: Individual cohort study.

Synopsis: The authors investigated the utility of silk fibroin patching in patients with chronic TM perforation. Forty patients were enrolled in the study; half underwent perichondrium myringoplasty, and the silk fibroin patch technique was applied in the remaining patients. The researchers compared the closure, otorrhea, and complication rates; closure time; post-operative hearing gain; and patient satisfaction between the two groups.

Demographic data (gender, site, age, duration, preoperative air–bone gap, and perforation size and location) were not significantly different between the two groups. The closure rates and times, complication rates, and postoperative hearing gains were also similar in both groups. The mean operative time, otorrhea rate, and complication rate were also significantly better in the silk fibroin patch group. The intraoperative dizziness scores were higher in the conventional perichondrium myringoplasty group.

Citation: Lee JH, Kim DK, Park HS, et al. A prospective cohort study of the silk fibroin patch in chronic tympanic membrane perforation. Laryngoscope. 2016;126:2798–2803.