gramicidin-a and Tympanic-Membrane-Perforation

Tympanic membrane perforations are common and can be categorised into either acute or chronic. Acute perforations are usually traumatic or inflammatory in origin and heal spontaneously. Chronic perforations may be associated with underlying progressive disease.. To differentiate between safe and unsafe perforations and describe management principles for these conditions.. The majority of acute tympanic membrane perforations heal spontaneously. Those that do not can be considered for surgical repair. Chronic perforations should be viewed as either safe or unsafe depending on the risk of progression to significant complications. Unsafe perforations are often associated with cholesteatoma (an epidermoid cyst of the middle ear and mastoid air cell system). Cholesteatoma destroys bone and causes serious ear and intracranial complications--surgery is commonly required.

Topics: Anti-Infective Agents, Local; Cholesteatoma, Middle Ear; Dexamethasone; Drug Combinations; Framycetin; Gramicidin; Humans; Tympanic Membrane Perforation

To assess the myringoplasty graft take rate, comparing two methods of post-operative ear packing: bismuth iodoform paraffin paste (BIPP) gauze versus tri-adcortyl ointment (TAO).. A retrospective study of patients who had undergone myringoplasty at our department within a three-year period was undertaken. Data, including age, site and size of perforation, grade of surgeon, surgical approach, use of post-operative ear dressings, complications, and audiometric outcome, were collected from the patient notes and analysed. The overall success rate of the operation (with success being defined as an intact tympanic membrane at six months) was noted.. One hundred and seventy myringoplasties were performed over the study period, but data were complete on 154 patients and these constituted the study population. Age ranged from nine to 71 years (mean age 34 years) and the mean follow-up period was seven months. Consultants performed 62 per cent of the operations, with an 85 per cent success rate, whereas trainees performed the remaining 38 per cent, with a success rate of 73 per cent (p=0.059). The overall success rate was 80 per cent; 79 per cent for BIPP and 83 per cent for TAO (p=0.55), and 87 per cent for small perforations and 75 per cent for subtotal perforations (p=0.22). There was audiometric improvement in 74 per cent of cases.. We found no significant difference in outcome between patients packed with TAO and BIPP. Packing with TAO is therefore a suitable alternative to BIPP gauze ear dressing following myringoplasty.

Topics: Adolescent; Adult; Aged; Bandages; Bismuth; Child; Drug Combinations; Female; Gramicidin; Humans; Hydrocarbons, Iodinated; Male; Middle Aged; Myringoplasty; Neomycin; Nystatin; Ointments; Postoperative Care; Retrospective Studies; Triamcinolone Acetonide; Tympanic Membrane Perforation; Wound Healing

In a retrospective study of patients who had undergone myringoplasty at our department within a 12-month period, we assessed the graft take rate using tri-adcortyl ointment (TAO) as ear dressing. Data including age, site and size of perforation, grade of surgeon, surgical approach, use of postoperative ear dressings, complications and audiometric outcome was collected from the patient notes and analysed. The overall success rate of the operation (with success being defined as an intact tympanic membrane at 6 months) was noted. Seventy-seven patients were operated, but data were complete on 64 patients and these constituted the study population. TAO was used in 95% of the patients and BIPP gauze pack in the remaining 5%. Age ranged from 8 to 63 years (mean 34 years). Mean follow-up period was 13 months. Most of the operations (72.88%) were carried out by consultants with a success rate of 89% and the remaining patients were operated by trainees with a success rate of 88% (P = 1.000). The overall success rate was 89, 90.16% for TAO and 66.66% (2 out of 3) for BIPP (P = 0.298), 95% for small and 86% for subtotal perforations (P = 0.573), 85% for anterior and 100% for posterior perforations (P = 0.240), 91% for adult patients and 88% for children (P = 1.000). TAO is a suitable ear dressing in myringoplasty. Routine use of TAO did not affect the success rate of myringoplasty at our centre.

Topics: Adolescent; Adult; Aged; Audiometry; Child; Drug Combinations; Female; Follow-Up Studies; Gramicidin; Hearing; Humans; Male; Middle Aged; Myringoplasty; Neomycin; Nystatin; Occlusive Dressings; Ointments; Otitis Media; Retrospective Studies; Rupture, Spontaneous; Treatment Outcome; Triamcinolone Acetonide; Tympanic Membrane Perforation

Although rare, ototoxicity from the use of aminoglycoside drops is well recognized. Ototoxicity has not been described with the use of combination aminoglycoside-steroid-antifungal creams or ointments. We present the case of a 60-year-old man with a perforated tympanic membrane who suffered a total hearing loss after the instillation of cream containing triamcinolone, neomycin, gramicidin and nystatin (Tri-Adcortyl cream) into his ear canal. On balance, we believe that a number of potentially ototoxic constituents in this cream were responsible. Other possible causes of sensorineural hearing loss and the possible mechanisms of ototoxicity of this cream are discussed. The reasons why such creams may be particularly ototoxic, compared with drops, are also considered. The authors caution against the use of such creams or ointments in the ear if there is any suspicion of a tympanic membrane perforation.

Topics: Administration, Topical; Anti-Bacterial Agents; Anti-Inflammatory Agents; Deafness; Drug Combinations; Drug Therapy, Combination; Gramicidin; Humans; Male; Middle Aged; Neomycin; Nystatin; Triamcinolone Acetonide; Tympanic Membrane Perforation

Topics: Administration, Topical; Adolescent; Anti-Bacterial Agents; Anti-Inflammatory Agents; Audiometry, Pure-Tone; Dexamethasone; Drug Therapy, Combination; Framycetin; Gentamicins; Gramicidin; Hearing Loss, Conductive; Humans; Male; Otitis Media with Effusion; Tympanic Membrane Perforation