STIMULATION OF EPITHELIAL HEALING IN CHRONIC POSTOPERATIVE OTORRHEA USING LYOPHILIZED CULTURED KERATINOCYTE LYSATES

Objective: After tympanoplasty, despite a closed tympanic graft, some patients continue to have persistent otorrhea due to insufficient epit helial healing and granulation tissue formation in the depths of the o uter ear canal. When all medical therapies fail, many otologists under take revision surgery, usually with free skin grafting. To avoid surge ry, the authors sought to improve this condition with a lysate of lyop hilized cultured allogeneic keratinocytes. Study Design and Patients: In this prospective pilot study, lyophilized cultured allogeneic kerat inocyte lysates have been administered in 27 patients. These patients had uncontrollable otorrhea that resisted medical (topical) therapy fo r at least 6 months. Main Outcome Measure: The criterion of success wa s a complete epithelialization and cessation of otorrhea. Results: Aft er an average of 2 applications, cessation of otorrhea was achieved in 20 cases (74%). Three patients (11%) relapsed after 3 months. The oth er ears (63%) still were dry at the 1-year final evaluation. Conclusio ns: These results are similar to those obtained after application of s heets of viable cultured keratinocytes of autologous as well as of all ogeneic origin. Because the soluble lysate can be incorporated into ot otopical drops, the lysate technique is more ''user-friendly'' and can be applicable in any outpatient clinic. Because keratinocytes contain many growth factors (e.g., epidermal growth factor, basic fibroblast growth factor, platelet-derived growth factor, transforming growth fac tor), the authors speculate that the release of those intracellular gr owth factors is responsible for the observed therapeutic effect. This form of therapy by its combination of several growth factors might be considered a more physiologic method than the, also still experimental , growth factor therapy in which high doses of only single growth fact or are used.