Estrada TCA, Martínez CJ, Díaz LMLV

Language: Spanish
References: 26
Page: 75-80
PDF size: 278.96 Kb.

ABSTRACT

Background
The chronic perforation of the tympanic membrane (TM) is a common clinical entity, frequent cause of functional deficit because of secondary hearing loss. Of multiples causes, the most important are infectious and postraumatic causes. The standard treatment is the surgical repair with grafts (myringoplasty).
Objetive
To evaluate the effectiveness of topical application of drugs that promotes healing (phenytoin and ketanserin) on the chronic perforations of the tympanic membrane.
Material and methods
A prospective, descriptive study was made. From May to November 2004, 27 patients with diagnosis of perforation of the tympanic membrane were studied; they were divided randomly in 3 groups: Group 1, control (N=9); Group 2, phenytoin treatment (14); and Group 3, ketanserin treatment (N=4). We evaluated radiographic studies and audiometric studies pre and postreatment, the follow-up was made to the 3, 5, and 7 weeks to determine their effect on the size of the perforation.
Results
We found a significant reduction in the size of perforation, with a total closure in 10 patients (71%), which was statistically significant, this effect wasn’t observed in the control group. In the ketanserin treatment group, the application was suspended for the secondary effects observed in the 100% of the patients (othorrea).
Conclusions
Treatment with topical phenytoin is a viable option to the surgical treatment in the handling of the chronic perforations of the tympanic membrane.

REFERENCES

1. Ma YX, Zhao H, Zhou XN. Topical treatment with growth factors for tympanic membrane perforations: progress towards clinical application. Acta Otolaryngol 2002;122:586-99.

2. Gladstone HB, Jackler RK, Varav K. Tympanic membrana wound healing. An overview. Otolaryngol Clin North Am 1995;28:913-32.

3. Clymer MA, Schwaber MK, Davidson JM. The effects of keratinocyte growth factor on healing of tympanic membrane perforations. Laryngoscope 1996;106:280-5.

4. Dvorak DW, Abbas G, Ali T, Stevenson S, Welling B. Repair of chronic tympanic membrane perforations with long-term epidermal growth factor. Laryngoscope 1995;105:1300-4.

5. Soumekh B, Hom DB, Levine S, Juhn SK, Antonelli PJ. Treatment of chronic tympanic-membrane perforations with a platelet-derived releasate. Am J Otol 1996;17:506-11.

6. Vartianen E, Nuutinen J. Success and pitfalls in myringoplasty: follow up study of 404 cases. Am J Otol 1993;14:301-5.

7. Laidlaw DW, Costantino PD, Govindaraj S, Hiltzik DH, Catalano PJ. Tympanic membrane repair with a dermal allograft. Laryngoscope 2001;111:702-7.

8. Kartush JM. Tympanic membrane patcher: a new device to close tympanic membrane perforations in a office setting. Am J Otol 2000;21:615-20.

9. Somers T, Goovaert G, Schelf hout L, Peeters S, et al. Growth factors in tympanic membrane perforations. Am J Otol 1998;19:428-34.

10. Hom DB. Growth factors in wound healing. Otolaryngol Clin North Am 1995;28:925-44.

11. Pendse AK, Sharma A, Sodani A, Hada S. Topical phenytoin in wound healing. Int J Dermatol 1993;32(3):214-7.

12. Furst W, Wildner R. Phenytoin and phenytoin derivates for local administration. Pharmazie 1991;46(6):424-6.

13. Yadav JK, Singhvi AM, Kumar N, Garg S. Topical phenytoin in the treatment of split-thickness skin autograft donor sites: a comparative study with polyurethane membrane drape and conventional dressing. Burns 1993;19(4):306-10.

14. Johnson TJ. Use of topical phenytoin for wound care. S D J Med 1998;51(10):387-8.

15. Rooman RP, Janssen H. Ketanserin promotes wound healing: clinical and preclinical results. Prog Clin Biol Res 1991;365:115-28.

16. Rhodes RS, Heyneman CA, Culbertson VL, Wilson SE, Phatak HM. Topical phenytoin treatment of stage II decubitus ulcers in the elderly. Ann Pharmacother 2001;35(6):675-81.

17. Carneiro PM, Rwanyuma LR, Mkony CA. A comparision of topical phenytoin with Silverex in the treatment of superficial dermal burns. Cent Afr J Med 2002;48(9- 10):105-8.

18. Carneiro PM, Nyawawa ET. Topical phenytoin versus EUSOL in the treatment of non-malignant chronic leg ulcers. East Afr Med J 2003;80(3);124-9.

19. Pai MR, Sitaraman N, Kotian MS. Topical phenytoin in diabetic ulcers: a double blind controlled trial. Indian J Med Sci 2001;55(11):593-9.

20. Apelqvist J, Castenfors J, Larsson J, Stenstrom A, Persson G. Ketanserin in the treatment of diabetic foot ulcer with severe peripheral vascular disease. Int Angiol 1990;9(2):120-4.

21. Martinez FR, Morales M, Castaneda M, Perez A, et al. Randomized single-blind trial of topical ketanserin for healing acceleration of diabetic foot ulcers. Arch Med Res 1997;28(1):95-99.

22. Bansal NK, Mukul. Comparison of topical phenytoin with normal saline in the treatment of chronic trophic ulcers in leprosy. Int J Dermatol 1993;32(3):210-3.

23. Salazar JJ, Serrano GG, León GI, Torres BM. Use of topical ketanserin for the treatment of ulcers in leprosy patients. Indian J Lepr 2001;73(2):103-10.

24. Das SJ, Olsen I. Up regulation of keratinocyte growth factor and receptor: a possible mechanism of action of phenytoin in wound healing. Biochem Biophys Res Commun 2001;282(4):875-81.

25. Scheinfeld N. Phenytoin in cutaneous medicine: its uses, mechanisms and side effects. Dermatol Online J 2003;9(3):6.

26. De Diego JI, Prim MP, Marcos S, De Sarria MJ, et al. Vestibular and hearing manifestations of phenytoin toxicity: a retrospective series. Ear Nose Throat J 2001;80(6):404, 407-9.