Utilising silk fibroin membranes as scaffolds for the growth of tympanic membrane keratinocytes, and application to myringoplasty surgery

Background: Chronic tympanic membrane perforations can cause significant morbidity. The term myringoplasty describes the operation used to close such perforations. A variety of graft materials are available for use in myringoplasty, but all have limitations and few studies report post-operative hearing outcomes. Recently, the biomedical applications of silk fibroin protein have been studied. This material’s biocompatibility, biodegradability and ability to act as a scaffold to support cell growth prompted an investigation of its interaction with human tympanic membrane keratinocytes. Methods and materials: Silk fibroin membranes were prepared and human tympanic membrane keratinocytes cultured. Keratinocytes were seeded onto the membranes and immunostained for a number of relevant protein markers relating to cell proliferation, adhesion and specific epithelial differentiation. Results: The silk fibroin scaffolds successfully supported the growth and adhesion of keratinocytes, whilst also maintaining their cell lineage. Conclusion: The properties of silk fibroin make it an attractive option for further research, as a potential alternative graft in myringoplasty.

Silk films as a repair material for perforations of the tympanic membrane

Large, chronic perforations of the tympanic membrane or eardrum can cause hearing loss as well as a range of secondary health problems. Current methods of repair usually involve grafting a material such as cartilage from another site on the body across the perforation. However, given problems such as possible infections at the graft donor site and the inability to see through the graft to assess infection within the middle ear, there is a need to develop an alternative material that is strong, readily available and transparent. Such a material would allow for less invasive surgery and potentially result in a superior hearing outcome for the patient. Our recent work has identified silk fibroin films as a promising material for this application. This paper reviews the repair of large perforations and compares the mechanical properties of silk with some existing graft materials. It also briefly discusses the difficulties in defining and comparing these properties with such different materials.

Assessing the validity of tympanic temperature to predict core temperature of firefighters in different environmental conditions

The present study examined the validity of tympanic temperature measurements as a predictor of core temperature on the fireground in different environmental conditions. Fiftyone volunteer firefighters participated in the study across four different conditions, the conditions consisted of; 1) passive (i.e., no intervention) cooling in cold ambient temperatures (0-6°C); 2) cooling (through water immersion) in cool ambient temperatures (10-12ºC); 3) cooling (through water immersion) in warm ambient temperatures (21.5°C); and, 4) passive cooling in warm ambient temperatures (22°C). Firefighters wore full structural personal protective clothing while performing common firefighting duties including search and rescue tasks for 20-40 minutes. There was no difference between core and tympanic temperature immediately post-exercise across any condition. However, for all conditions, tympanic temperature dropped significantly faster than core temperature from 0 minutes, and remained significantly lower (p < 0.05) than core temperature from nine to 20 minutes post-training. The results show that there is no consistent difference between core and tympanic temperature during recovery from a simulated firefighting task across a range of different ambient conditions. Agencies should, accordingly, prioritize investigating other practical markers of core temperature as part of a broader heat stress management plan for firefighters.

Comparative acoustic performance and mechanical properties of silk membranes for the repair of chronic tympanic membrane perforations

The acoustic and mechanical properties of silk membranes of different thicknesses were tested to determine their suitability as a repair material for tympanic membrane perforations. Membranes of different thickness (10-100μm) were tested to determine their frequency response and their resistance to pressure loads in a simulated ear canal model. Their mechanical rigidity to pressure loads was confirmed by tensile testing. These membranes were tested alongside animal cartilage, currently the strongest available myringoplasty graft as well as paper, which is commonly used for simpler procedures. Silk membranes showed resonant frequencies within the human hearing range and a higher vibrational amplitude than cartilage, suggesting that silk may offer good acoustic energy transfer characteristics. Silk membranes were also highly resistant to simulated pressure changes in the middle ear, suggesting they can resist retraction, a common cause of graft failure resulting from chronic negative pressures in the middle ear. Part of this strength can be explained by the substantially higher modulus of silk films compared with cartilage. This allows for the production of films that are much thinner than cartilage, with superior acoustic properties, but that still provide the same level of mechanical support as thicker cartilage. Together, these in vitro results suggest that silk membranes may provide good hearing outcomes while offering similar levels of mechanical support to the reconstructed middle ear.

Grafts in myringoplasty : utilizing a silk fibroin scaffold as a novel device

Chronic perforations of the eardrum or tympanic membrane represent a significant source of morbidity worldwide. Myringoplasty is the operative repair of a perforated tympanic membrane and is a procedure commonly performed by otolaryngologists. Its purpose is to close the tympanic membrane, improve hearing and limit patient susceptibility to middle ear infections. The success rates of the different surgical techniques used to perform a myringoplasty, and the optimal graft materials to achieve complete closure and restore hearing, vary significantly in the literature. A number of autologous tissues, homografts and synthetic materials are described as graft options. With the advent and development of tissue engineering in the last decade, a number of biomaterials have been studied and attempts have been made to mimic biological functions with these materials. Fibroin, a core structural protein in silk from silkworms, has been widely studied with biomedical applications in mind. Several cell types, including keratinocytes, have grown on silk biomaterials, and scaffolds manufactured from silk have successfully been used in wound healing and for tissue engineering purposes. This review focuses on the current available grafts for myringoplasty and their limitations, and examines the biomechanical properties of silk, assessing the potential benefits of a silk fibroin scaffold as a novel device for use as a graft in myringoplasty surgery.

Preliminary results of the application of a silk fibroin scaffold to otology

The surgical treatment to repair chronic tympanic membrane perforations is myringoplasty. Although multiple autologous grafts, allografts, and synthetic graft materials have been used over the years, no single graft material is superior for repairing all perforation types. Recently, the remarkable properties of silk fibroin protein have been studied, with biomedical and tissue engineering applications in mind, across a number of medical and surgical disciplines. The present study examines the use of silk fibroin for its potential suitability as an alternative graft in myringoplasty surgery by investigating the growth and proliferation of human tympanic membrane keratinocytes on a silk fibroin scaffold in vitro. Light microscopy, immunofluorescent staining, and confocal imaging all reveal promising preliminary results. The biocompatibility, transparency, stability, high tensile strength, and biodegradability of fibroin make this biomaterial an attractive option to study for this utility.