Kojima, Hiromi1; Yamamoto, Kazuhisa1; Morino, Tunetaro1; Kasai, Yoshiyuki1
1 Departmentof Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan.
In order for a normal middle ear cavity to be formed after surgery, regeneration of the middle ear mucosa is essential. However, in the presence of otitis media, middle ear mucosal function is inherently damaged and complicates the creation of an effectively aerated tympanic cavity, because postoperative regeneration of the middle ear mucosal epithelium is delayed. Under the circumstances,there is no method that can surely prevent re-adhesion of the tympanic membrane. If regeneration of the damaged middle ear mucosa is possible in adhesive otitis media patients, it would also be possible to prevent re-adhesion of the tympanic membrane and recurrence of adhesive otitis media.
To overcome these limitations, we developed a novel method combining TEES and autologous nasal mucosal epithelial cell sheet transplantation for postoperative regeneration of the middle ear mucosa and prevention re-adhesion of the tympanic membrane.
We corrected a piece of inferior nasal turbinate mucosal tissue. Tissue-engineered autologous nasal mucosal epithelial cell sheets were fabricated by culturing the harvested cells. The cultivated cell sheets were transplanted during TEES, onto the exposed bony surface of the tympanic cavity where the mucosa had been lost. Additionally, a tympanic membrane was fashioned using the cartilage/cell sheet hybrid.
We successfully performed this procedure on two patients with adhesive otitis media. Re-adhesion of tympanic membrane was prevented by grafting the cell sheet on the promontory and to the rear surface of the newly fashioned tympanic membrane. This novel method was considered to have good indication for cell sheet transplantation in tympanic cavity.