- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01958749
Fat Graft Myringoplasty With and Without Platelet Rich Plasma (PRP) for Treating Smaller Tympanic Membrane Perforations
Efficacy of Fat Graft Myringoplasty Versus Fat Plus Platelet Rich Plasma (PRP) Myringoplasty in Closing Smaller Tympanic Membrane Perforations in an Outpatient Setting: a Randomized Study
The current standard treatment for chronic tympanic membrane perforations (TMP) involves having fat grafted from the patient and inserted into the ear, through the perforation, to promote healing using the fat graft myringoplasty (FGM) technique. Platelet rich plasma (PRP) has also been used to promote TMP healing and involves having the patient provide a blood sample, which is processed to produce PRP and applied to the perforation. This prospective, multi-centre study will evaluate whether combining both these techniques can improve the rate of closure in patients with chronic TMP involving <50% of the membrane.
Patients will be randomized to receive either the standard FGM treatment or FGM treatment with the addition of PRP. At 3 months postintervention a blinded observer will rate the degree of TMP closure. Differences in closure rates between the 2 groups will be compared.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
This will be a multi-centre, single-blinded, randomised control trial. Patients will be randomised at each site to undergo FGM with or without PRP.
Step 1 in both groups is the same. Under LA (or GA if the patient is unable to tolerate this), a fat graft is taken from just behind the mastoid process, or more posteriorly just beneath the hairline if necessary. The graft is kept moist in 0.9% saline.The ear canal is injected with LA and the edges of the perforation are freshened. Gelfoam is placed into the middle ear and the fat graft placed on top of this until it touches the underside of the TM and slightly bulges through. In an attempt to achieve standardisation of surgical technique between sites, surgeons will be provided with an operative video to watch beforehand.
Step 2. The surgeon is informed of the randomisation outcome into Group 1 or 2. Group 1 (Non PRP): patients will have FGM alone, and this will simply be covered with a piece of saline-soaked Gelfoam cut to completely cover the perforation and graft.
Group 2 (PRP): as for Group 1, but the Gelfoam will instead be soaked in PRP derived from the patient's own whole blood. The generation of PRP is descibed below: -
- 10-20 mL of autologous blood collected from an antecubital vein is placed in an adenosine citrate dextrose-acid (ACD-A) collection tube to prevent premature activation
- Blood immediately placed in the centrifuge at 1100g for 10 minutes (once)
- Supernatant removed and collected into syringe
- Injected onto surface of fat graft
- Rest added to piece of gelfoam
- Place gelfoam + PRP on the TM perforation
Post op care: patients will be asked to keep their ear dry, and cover it with a cotton ball when taking a shower or bathing for the first week, but otherwise to leave it open. They will be given an eye dropper, and instructed to use 2 drops of white vinegar in the ear three times a day for 10 days, with the head tilted over to allow the vinegar to reach the fat graft. Vinegar drops are an effective treatment for Pseudomonas infection, the most common infection in the external ear canal, and are commonly used in external ear infections. If this causes any discomfort, the patients will be instructed to stop this, and this information will be recorded at first follow up. If there is infected discharge, the patient will be instructed to contact the surgeon, and will be treated with ciprofloxacin-containing eardrops for one week. The occurrence of such an event will be recorded, but will not be a censoring event for the purposes of the study.
Follow up schedule: Patients will be followed at 2 weeks, 6 weeks and 3 months post surgery.
A planned interim analysis will be performed at the half-way point of the study; each centre will be compared for heterogeneity with the other sites using ANOVA, for both group 1 and group 2. Data from sites with heterogeneous data may be discarded, and/or other sites recruited, and/or existing site enrollments increased as needed to allow adequate patient recruitment.
Our primary outcome measure will be tested with an unpaired t-test between the two groups. The investigators will also perform secondary analyses of the degree of closure in the non-complete closure populations between the two treatment arms using Wilcoxon non-parametric testing
Power analysis: the investigators have deemed a 30% difference in closure rate between the two groups as clinically significant. The investigators estimate the closure rate for the fat alone to be 50%, based on previous publications. To show a difference of closure rate of 70% in the blood treated group, with a power of 0.8 and an alpha error of 0.05 would require 45 subjects in each group. This is for a binary outcome of pass fail. The investigators anticipate some drop out, because of failure of follow up, in the order of 30% at 3 months, and so aim to recruit 46 subjects in each arm.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Manohar Bance, MD
- Phone Number: 902-473-5955
- Email: m.bance@dal.ca
Study Locations
-
-
British Columbia
-
Vancouver, British Columbia, Canada
- Providence Health St Paul's Hospital
-
Principal Investigator:
- Brian Westerberg, MD
-
-
Nova Scotia
-
Halifax, Nova Scotia, Canada, B3H 2Y9
- ENT department, Victoria General Hospital
-
Principal Investigator:
- Manohar Bance, MD
-
Sub-Investigator:
- James Rainsbury, BMBS FRCS
-
-
-
-
-
Stoke-on-Trent, United Kingdom
- University Hospital North Staffordshire
-
Principal Investigator:
- Sanjiv Kumar, FRCS
-
-
Devon
-
Plymouth, Devon, United Kingdom
- Derriford Hospital
-
Principal Investigator:
- James Rainsbury, BMBS FRCS
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Tympanic membrane perforation measuring <50% of the area of the membrane
- Perforation present for at least 6 months (based on history or direct observation)
- All edges of perforation are visible
Exclusion Criteria:
- Active ear infection at the time of the procedure
- cholesteatoma present
- Patients on immunosuppressive therapy (including oral steroids) or chemotherapy
- Patients with previous failed attempt at perforation repair
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
No Intervention: Fat graft without Platelet Rich Plasma
Step 1. Under Local Anaesthetic (or General Anaesthetic if the patient is unable to tolerate this), a fat graft is taken from just behind the mastoid process, or more posteriorly just beneath the hairline if necessary. The graft is kept moist in 0.9% saline.The ear canal is injected with local anaesthetic and the edges of the perforation are freshened. Gelfoam is placed into the middle ear and the fat graft placed on top of this until it touches the underside of the TM and slightly bulges through. In an attempt to achieve standardisation of surgical technique between sites, surgeons will be provided with an operative video to watch beforehand. Step 2. The fat graft will simply be covered with a piece of saline-soaked Gelfoam cut to completely cover the perforation and graft. |
|
Experimental: Fat graft with Platelet Rich Plasma
Procedure as for as for Fat graft without PRP, but at Step 2 the Gelfoam will instead be soaked in PRP derived from the patient's own whole blood. The generation of PRP is descibed below: -
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Presence or absence of tympanic membrane perforation
Time Frame: 3 months
|
3 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Degree of perforation closure
Time Frame: 3 months
|
4 Groups: Total, almost complete (very small residual perforation), substantial (>50% closure), partial (<50% closure)
|
3 months
|
Infection rate
Time Frame: 3 months
|
Infection measured by presence of mucopurulent discharge from operated ear
|
3 months
|
Discomfort on using vinegar drops
Time Frame: 2 weeks
|
2 weeks
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Manohar Bance, MD, Capital Health, Canada
Study record dates
Study Major Dates
Primary Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- CDHA/Fat Graft Myringoplasty
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Tympanic Membrane Perforation
-
Astellas Pharma Global Development, Inc.TerminatedChronic Tympanic Membrane PerforationUnited States
-
Cook Research IncorporatedRecruiting
-
Abd-Elazeem Abd-Elhameed ElbakryCompletedTympanum; PerforationEgypt
-
University of British ColumbiaCompleted
-
Central Adelaide Local Health Network IncorporatedUniversity of AdelaideRecruitingSurgery | Otitis Media | Tympanic Membrane Perforation | Tympanic Membrane InflammationAustralia
-
Assiut UniversityUnknownTympanic Membrane Perforation
-
Dr. Bradley WellingUnited States Department of DefenseCompletedTympanic Membrane PerforationUnited States
-
Mohammad Sadegh Bagheri BaghdashtCompletedTympanic Membrane Perforation
-
Assiut UniversityUnknownTympanic Membrane Perforation
-
University of PittsburghDepartment of Pediatric OtolaryngologyTerminatedTympanic Membrane PerforationUnited States
Clinical Trials on Fat graft with Platelet Rich Plasma
-
University College, LondonCompletedDiabetes Mellitus Foot UlcerUnited Kingdom
-
Dow University of Health SciencesCompleted
-
Istituto Ortopedico RizzoliActive, not recruiting
-
University Hospital, Basel, SwitzerlandSwiss National Science Foundation; Wuerzburg University Hospital; Clinical Trial...Not yet recruitingPatellofemoral OsteoarthritisSwitzerland, Germany
-
Ain Shams UniversityCompleted
-
Noha Mohsen OmarMenoufia UniversityCompletedChronic Ulcer of Leg or Foot | Chronic Venous Hypertension With Ulcer and Inflammation
-
Michael Fredericson, MDFactor MedicalRecruitingCarpal Tunnel Syndrome | PRPUnited States
-
University of Southern CaliforniaEnrolling by invitationHiatal Hernia Large | Reflux, GastroesophagealUnited States
-
Centre of Postgraduate Medical EducationCompleted
-
Stanford UniversityPartnership for Clean CompetitionCompletedRheumatic Diseases | TendinopathyUnited States