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A Breakthrough research on the Efficacy of EGF and Gelatin Sponge for TMPs by Zheng Cai Lou

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A Breakthrough research on the Efficacy of EGF and Gelatin Sponge for TMPs by Zheng Cai Lou

November 16
23:15 2018

The brilliant research on the Efficacy of EGF and Gelatin Sponge for Traumatic Tympanic Membrane Perforations (TMPs) was conducted by Zheng Cai Lou and Zihan Lou. The paper was published with the American Academy of Otolaryngology-Head and Neck Surgery Foundation. DOI: 10.1177/0194599818792019

The goal of Zheng’s and Zihan’s study was to compare the outcomes of epidermal growth factor (EGF) and gelatin sponge patch treatments for traumatic tympanic membrane perforations.

The work was reviewed and approved by the Institutional Ethics Review Board of the Wenzhou Medical University of Yiwu Hospital, China. All the work was performed with the Helsinki Declaration.

The subjects were recruited consecutively from patients diagnosed with traumatic TMPs who had visited the Department of Otorhinolaryngology-Head, and Neck Surgery at the Yiwu Hospital of Wenzhou Medical University between January 2015 and June 2017.

The inclusion criteria were a traumatic TMP, age more than 16 years, and perforation of at least 50% of the pars tensa. The exclusion criteria were a middle ear infection or severe vertigo at the time of the hospital visit, suspicion of ossicular chain damage or granulation tissue hyperplasia, an additional injury associated with the inability to walk independently (craniocerebral injury in particular), and patient relocation from the region served by the hospital (associated with the loss of follow-up).

During the patient’s visit to the hospital the age, sex, date of injury, the cause of injury, size of the TMP, and presence or absence of otorrhea were recorded. To get accurate results the scientists assessed each patient. Each subject was endoscopically examined after cerumen and/or blood clots in the external auditory canal (EAC) were removed with a cotton bud soaked in the povidone-iodine solution, and the site and size of the perforation were documented.

The sizes of TMPs were analyzed with ImageJ software and perforation size was graded into large and subtotal perforation (>50% and 75% of the eardrum, respectively).

In total, 141 perforations encompassing more than 50% of the eardrum were randomly divided into three groups: EGF (n=47), and observation (n=47). The edges of the perforations were not approximated. The closure rate, mean closure time, and infection rate were evaluated at 6 months and the following were analyzed for their influence on healing outcome: sex, side of the ear, position of the perforation, cause of the injury, size of the perforation, pre-existing myringosclerosis, inverted edge, age, duration of perforation and infection-related factors analyzed.

A total of 135 perforations were analyzed. On analysis, it was found that at 6 months, the closure rates were 97.8%, 86.7% and 82.2% in the EGF, gelatin sponge patch, and spontaneous healing groups, respectively. It was also noticed that the presence of infection was not significantly associated with the rate of closure in any group.

After all the results were compiled, it was observed that on comparison with spontaneous healing, daily application of EGF and gelatin sponge patches reduced the closure time of traumatic tympanic membrane perforations. EGF treatment had a high closure rate and shorter closure time. However, this resulted in otorrhea. In contrast, gelatin sponge patches did not improve the closure rate or cause otorrhea, instead required repeated patch removal and reapplication.

The scientists concluded the breakthrough research and suggested that daily application of EGFs should be recommended for traumatic TMPs to improve aural fullness and tinnitus and prevent further failure of eardrum healing.

In addition, the EGF treatment is simple, convenient, inexpensive ($4), and non-invasive. It can be performed on an outpatient basis. A clinical study to determine the optimum dosage and timing of EGF treatment for traumatic TMPs is warranted. Thus the appropriate treatment should be selected according to patient need.

The authors of the research have done a great job in assessing EGF. This research will immensely contribute to saving people from this disease. The young scientists too can make further advancements in this area of medical science.

Both Zheng Cai Lou and Zihan Lou made individual contributions to this paper. Zheng interpreted the data for the work, worked on the design for the work etc whereas Zihan Lou worked on the analysis of the data etc.

Both the scientists will be lauded in the medical world for this huge contribution in decoding the EGF treatment.

About Prof. Zheng-Cai Lou 

Prof. Zheng-Cai Lou received his diploma in Clinical Medicine in 1993 at the wenzhou medical University, China. He works on the Otorhinolaryngology. He did his Associate Chief Physician and Chief Physician in otorhinolaryngology between 2004 and 2009 at the Health & Medicine Agency of Zhejiang Province, China.

He is a Senior Visiting Scholar at the University of Pennsylvania in 2013. He is a postgraduate tutor of wenzhou medical University at present and member international regular of American Academy of Otolaryngology-Head and Neck Surgery. He is now leading the department of Otorhinolaryngology at the affiliated yiwu hospital of wenzhou medical university, China. He has published more than 300 peer-reviewed papers.

His research focus lies in the field of the regeneration of tympanic membrane, tympanoplasty, the mechanism of growth factors on the treatment of tympanic membrane perforation (TMP), and epistaxis. He and his team found that topical application of growth factors (e.g. EGF, FGF2) alone without scaffold accelerate the healing of TMPs, the best dosage is to keep the moist environment of the eardrum and middle ear rather than wet or dry.

In addition, they also found that topical application of Ofloxacin Ear Drops aid the healing of human TMPs. They concluded that moist may facilitate the healing of TMPs while dry perforations prolong the healing time and result in the failure of healing. They found a new migration pattern of epithelium of eardrum during the healing process of TMP, that is outward migration. Outward migration only translated into the centripetal migration and close the perforation, otherwise, it will prolong the healing time and result in the failure of healing.

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