Article adapted by Medical News Today from original press release.

A revolutionary surgical technique for treating perforations of the tympanic membrane (eardrum) in children and adults has been developed at the Sainte-Justine University Hospital Centre, an affiliate of the Universite de Montreal, by Dr. Issam Saliba. The new technique, which is as effective as traditional surgery and far less expensive, can be performed in 20 minutes at an outpatient clinic during a routine visit to an ENT specialist. The result is a therapeutic treatment that will be much easier for patients and parents, making surgery more readily available and substantially reducing clogged waiting lists.

“In the past five years, I’ve operated on 132 young patients in the outpatient clinic at the Sainte-Justine UHC using this technique, as well as on 286 adults at the University of Montreal Hospital Centre (CHUM) outpatient clinic,” says Dr. Saliba. “Regardless of the size of the perforation, the results are as good as those obtained using traditional techniques, with the incomparable advantage that patients don’t have to lose an entire working day, or 10 days or more off school in the case of children.”

The technique, which Dr. Saliba has designated “HAFGM” (Hyaluronic Acid Fat Graft Myringoplasty), requires only basic materials: a scalpel, forceps, a probe, a small container of hyaluronic acid, a small amount of fat taken from behind the ear and a local anesthetic. The operation, which is performed through the ear canal, allows the body by itself to rebuild the entire tympanic membrane after about two months on average, allowing patients to recover their hearing completely and preventing recurring cases of ear infection (otitis). Because it requires no general anesthetic, operating theatre or hospitalization, the technique makes surgery much more readily available, particularly outside large hospital centres, and at considerably lower cost.

“With the traditional techniques, you have to be on the waiting list for up to a year and a half in order to be operated on. Myringoplasty (reconstruction of the eardrum) using the HAFGM technique reduces waiting times, cost of the procedure and time lost by parents and children. What’s more, it will help clear the backlogs on waiting lists,” Dr. Saliba says.

Perforations of the eardrum

Myringoplasty is surgical procedures to repair the tympanic membrane or eardrum when it has been perforated or punctured as the result of infection, trauma or dislodgement of a myringotomy tube (also known as a pressure equalization tube). Surgical repair of the perforation will allow the patient to recover his or her hearing and prevent repeated ear infections, particularly after swimming or shower. Traditionally, these procedures are performed using what are known as lateral and medial techniques, which require hospitalization for at least one day, and 10 to 15 days off work. Every year in Quebec, some 750 myringoplasties are performed on adult or child patients.

Details of the study

This world premiere of a new form of eardrum surgery is based on results of a four-year prospective cohort study of 208 children and adolescents, 73 of whom were treated using the new HAFGM technique. This study was published on December 16, 2011 in the scientific journal Archives of Otolaryngology – Head and Neck Surgery by Dr. Issam Saliba, otolaryngologist (ear, nose and throat or ENT specialist), surgeon and researcher at the Sainte-Justine University Hospital Centre affiliated with the Université de Montréal, where he is also professor of otology and neuro-otology. Dr. Saliba is also a surgeon and researcher at the CHUM, where he conducted a similar study, applying the same HAFGM technique to cohorts of adult patients between 2007 and 2010, with publication in the August 20, 2008 issue of the scientific journal /i>Clinical Otolaryngology and subsequently in the February 12, 2011 issue of The Laryngoscope. The University of Montreal and Sainte-Justine University Hospital Centre are known officially as Université de Montréal and Centre hospitalier universitaire Sainte-Justine, respectively.

According to the company, cochlear synaptic tinnitus is the most common cause of tinnitus and is due to disturbed interplay of receptors on the postsynaptic membrane between inner hair cells and dendrites. Disturbed interplay creates a state of spontaneous depolarization, causing patients to continuously hear a sound.

Tinnex is described as a glutamate antagonist with a single injection that corrects the spontaneous depolarization state. Receptors start functioning again in a normal physiological way, giving permanent cure from tinnitus to patients, the company claims. It also says that no adverse effects have been noticed during its clinical studies of the drug.

Lincoln Pharmaceuticals says it is exploring other countries to introduce Tinnex. More information is available on the company’s website.

SOURCE: News reports and Tinnex

In gene therapy, genetic material — DNA or RNA — is transported by a carrier to cells to provide instructions for and replace damaged genes. The carrier must protect its genetic package and help it make its way through the membranes that protect cells and their surroundings. The carrier should also be able to transport the genetic material right to the cells that need help.

For the first time ever, chitosan nanoparticles have been used as a carrier for gene therapy in the ear. Chitosan is produced from shrimp shells.

“Gene therapy may someday be an alterna­tive to using surgery to implant CI, cochlear implants, in the deaf and hard of hearing,” says Sabina Strand, at NTNU’s Department of Biotechnology.

Basic research promising

Strand studies the use of chitosan in gene therapy, and conducted this basic research, now ended, in cooperation with the Karolinska Institutet in Sweden. Here, researchers attempted to use chitosan as a carrier to deliver drugs and genes to the inner ear in guinea pigs. Chitosan was able to deliver drugs through the membrane that covers the tiny gap between the middle ear and inner ear. Chitosan was also able to deliver genes to the hair cells. Whether or not the results from guinea pigs can be transferred to human ears remains uncertain.

“However, chitosan is non-toxic and is not harmful to cells. Chitosan is therefore better than other carriers and has characteristics that mean it could potentially be used with patients,” says Strand.

Tidy packages

Chitosan is produced from powdered shrimp shells. Acid removes salts, minerals and calcium carbonate. Strong alkalis and heat remove proteins. What remains is chitosan.

Extremely small nanoparticles in the range of 50-200 nm (nanometres) are formed spon­taneously when the positively charged chitosan and negatively charged genes are mixed. Chitosan does a good job packaging up DNA and RNA’s relatively large molecules.

Tailored therapy

In the body, chitosan attaches itself to molecules, cells and membranes. When the nanoparticles have passed through a membrane, chitosan packages up the gene molecules so they return to their normal size again. Chitosan also creates gaps between cells, which facilitate the absorption of medicine.

Different forms of gene therapy require nanoparticles with different properties. The properties of nanoparticles are controlled by the way in which researchers tailor the chitosan structure, its molecular size and 3D architecture. But whether or not researchers will find the perfect mix of medicines for our ears and hair cells remains to be seen — and heard.