TITLE: Improvement of Eustachian Tube Function by

Tissue-Engineered
Regeneration of Mastoid Air Cells
S!RCE "
#in$" http"%%&&&'ncbi'nlm'nih'gov%pmc%articles%(MC)*++,-)%
#aryngoscope' ./0) February1 0.)2.3" ,4.5,46'
(MCI7" (MC)*++,-)
(ublished online ./0. ctober 0+' doi" 0/'0//.%lary'.)6.6
Shin-ichi Kanemaru, MD. PhD, Hiroo Umeda, MD. PhD, Masaru Yamashita, MD. PhD, Harukau Hiraumi, MD. PhD,
Shi!eru Hirano, MD. PhD, Tatsuo "akamura, MD. PhD, and #uichi Ito, MD. PhD
Author information"
1. Department of Otolaryngology, The Foundation for Biomedical Research and Innovation, Koe, !apan
". The Department of Otolaryngology#$ead and %ec& 'urgery, (edical Research Institute, Kitano $ospital, Osa&a,
!apan
). Department of Otolaryngology, 'hi*uo&a +eneral $ospital, 'hi*uo&a, !apan
,.Department of Otolaryngology#$ead and %ec& 'urgery, +raduate 'chool of (edicine, Kyoto -niversity, Kyoto,
!apan
.. Department of Bioartificial Organs, Institute for Frontier (edical 'ciences, Kyoto -niversity, Kyoto, !apan
correspondence to : 'hin/ichi Kanemaru, (D, 0hD, Department of Otolaryngology, $ead and %ec&
'urgery, (edical Research Institute, Kitano $ospital, Osa&a, !apan1 "/,/"2 Ohgimachi, Kita&u, Osa&a, .)2/3,32,
!apan. 4/mail5 &anemaru6ent.&uhp.&yoto/u.ac.7p
8opyright9 "21" The :merican ;aryngological, Rhinological, and Otological 'ociety, Inc.
INTRODUCTION:
The revie< is a critical analysis of the article= Improvement of 4ustachian Tue Function y Tissue/4ngineered
Regeneration of (astoid :ir 8ells= pulished in the ;aryngoscope.
In the revie< of this article, first to summarise it, then to analyse its print structure, &eeping in vie< its layout and
reader friendly ease. ;astly the revie< aims to<ards a criti>ue analysis of the article evaluating its authority,
currency, accuracy, o7ectivity and coverage.:ny tales, graphs, diagrams and illustrations <ill also e analy*ed.
ARTICLE SUMMARY:
The purpose of this article is to assess the aility of regenerated mastoid air cells ?(:8s@ to restore normal gas
eAchange function and helps to improve poor 4ustachian tue ?4T@ function in patients <ith chronic otitis media
? 8O(@ y using tissue engineering method B 1C. This article comprises a prospective randomised control study of
'eventy/siA patients <ith 8O( , <ho received tympanoplasty <ith mastoidectomy and (:8 regeneration therapy
in a t<o/stages. During first stage artificial pneumatic ones <ere implanted and in second stage, a nitrous oAide
?%O"@ gas study <as performed, oth in patients <ith good (:8 regeneration and <ith poor (:8 regeneration to
measure middle ear pressure ?(40@. For the control group, (40 <as also measured in patients <ith good (:8
development during cochlear implantation or facial nerve decompression. 4T function <as measured t<ice in each
patient, once efore the 1st operation and D months after the second operation. Recovery of mastoid aeration and
regeneration of the pneumatic air cells <ere assessed y perfoming high resolution computed tomography ?$R8T@
scan images ta&en efore and then D months after the operations, respectively B"C. 'tatistical analysis <as carried
out using '0'' soft<are. Results <ere analy*ed using using 8hi/ s>uare test. 0 E 2.2. <as ta&en as a level of
statistical significance. The discussion include that most cases of 8O( sho<s poor development of (:8s and
poor 4T function. :lthough tympanoplasty <ith mastoidectomy is presently the est operative treatment for 8O(
ut recurrence is very common even after operation. (40 is regulated not only y the 4T ut also y (:8s. This
article summari*es that tissue/engineered regeneration of (:8s improves 4T function and gas eAchange in the
middle ear and (40 increased in the group <ith good (:8 regeneration after administration of %"O gasB)C.
ARTICLE STRUCTURE:
The article is availale as 0uReader; ePub (beta) & PDF (629K)
The article <as introduced <ith an :stract including an O7ective, 'tudy design, (ethod, Result and 8onclusion.
The operative method for (:8 regeneration has een descried in details. The result has een elaorated y use of
tales. The discussion on importance of (:8 regeneration and its outcomes on 4T function is promising. The
online article lin&s included 0umed, (ed+en and related citations. The full teAt version is free to users including
0DF format printout. 0reviously one article on same topic, had also een pulished in same 7ournal 5 Regeneration
of mastoid air cells in clinical applications y in situ tissue engineering. Kanemaru S, Nakamura T, Omori K,
Magrufov A, Yamashita M, Ito J. Laryngoscoe. !""# $e%& ''#(!)*!#+,- ./0.
ARTICLE CRITIQUE:
AUTHORITY:
4stalished in 13FD, for more than 122 years, otolaryngologists, clinicians, and researchers around the <orld have
read The ;aryngoscope to &eep pace <ith and learn ho< to ta&e advantage of the most important advances in the
diagnosis and treatment of head and nec& disorders. This 7ournal is the first choice among otolaryngologists to
pulish their most important findings and share their o<n successful techni>ues <ith their colleagues. This is the
highest ran&ed otolaryngology 7ournal, pulished monthlyB.C. I'I !ournal 8itation Reports 9 Ran&ing5 "21"5 GH,,
?Otorhinolaryngology@1 G"H1"1 ?(edicine Research I 4Aperimental@. Online I''%5 1.)1/,FF. BDC.
The editor in chief include 0rof (ichael +. 'te<art? (D, (0$@. The assistant editor include 0rof Roert 8. Kern,
(D and others.
The author 'hin/ichi Kanemaru has another pulication in !ournal of Tissue 4ngineering Regenerative (edicine
named J Glottic regeneration with a tissue-engineering technique, using acellular etracellular !atri
sca""ol# in a canine !o#e$ % recentl& 'ublishe# on (anuar& ), 2*+, $
ACCURACY:
The article reveals that it is a prospective randomi*ed control study. : prospective study is a cohort study that
follo<s over time a group of similar individuals ?cohorts@ <ho differ <ith respect to certain factors under study, to
determine ho< these factors affect rates of a certain outcome BGC and randomi*ed control trial ? R8T@ name only for
trials that contain control groups, in <hich groups receiving the eAperimental treatment are compared <ith control
groups receiving no treatment ?a placeo/controlled study@ or a previously tested treatment ?a positive/control
study@. In prospective cohort study investigators egin enrolling su7ects and aseline information is collected,
after this su7ects are then follo<ed Klongitudinally,K i.e. over a period of time, usually for years, to determine if
and <hen they ecome diseased and <hether their eAposure status changes. In this <ay, investigators can eventually
use the data to ans<er many >uestions aout the associations et<een Kris& factorsK and disease outcomes.
0rospective cohort studies are typically ran&ed higher in the hierarchy of evidence than retrospective cohort
studies B)C and can e more eApensive than a case#control study.
CURRENCY:
This paper <as presented at the Triology :nnual (eeting, 'an Diego, 8alifornia, -.'.:., :pril 13#"", "21" and
accepted on !uly F, "21". It <as printed online on Octoer 1F, "21". The research it descries is current and article
cites references in ody of teAt ranging from 1FFG/ "212.The article has also een cited in the ;aryngoscope
Feruary "21)1 1")?"@5 ,G"#,GD.
RELEVANCE:
This <as a scientific 7ournal on a scientific dataase. It <as <ritten to inform otolaryngologists and clinical
researchers in visual science rather than to entertain, advertise or promote a particular rand. The article is of
particular interest to any general otolaryngologist ut particulary to a <or&er in the field of mastoid ear disease.
This is an easy article to read and <ill e relevant to post graduate students of otolaryngology. This article <ill also
e of special interest to the health<or&ers in otolaryngology <ho deals many cases of intractale 8O( on daily
asis, <here simple tympanoplasty <ith mastiodectomy sho< poor development of (:8s and poor 4T function.
OBJECTIVITY:
This article provides information of the latest evidence relating to the understanding of 8O( and its complications,
current treatment strategies, their limitations, ne< areas of research regarding the importance of mastoid cells
regeneration in management of the patients. The authorLs further d<ell upon t<o stage procedure for the
development of (:8s via y artificial pneumatic one implantation follo<ed y %O" gas study. The article not
only sho<s good (:8 regeneration, ut also correlates closely <ith recovery of 4T function and gas eAchange
function. The information <as <ell supported and <ith ade>uate sample si*e and <ith all evidence ac&no<ledged
and referenced. There is no evidence of ias, a fact that is reinforced y the recognition and inclusion of the article
in one of the most prestigious peer revie<ed 7ournals of the su7ect.
STABILITY:
The article <ith its source an internationally acclaimed scientific 7ournal on an academic data ase is stale as a
resource. The article is also eing cited in further research papers. The results from the study underta&en are also
fairly impressive and the trial <as endorsed y an university of international repute.
:nalysis of +raphH ImageHTale5
Tale 1 sho<s patient profile et<een the age "#3) ?:vg. .".)@
Tale " that regeneration of (:8s correlates closely <ith recovery of 4T function and gas eAchange function.
Figure 1 sho<s the operative procedures for the first regenerative operation
Figure " sho<s measurement of middle ear pressure
Figure ) sho<s regenerated mastoid air cells after reopening the mastoid cavity at the second/stage operation
Figure , sho<s changes in middle ear pressure after administration of %"O gas.
Figure . sho<s relationship et<een (:8 regeneration and 4T function.
Overall all the tales and figures are very precise and clearly eAplain the t<o stage procedure and their outcomes.
RECENT ADVANCES RELATED TO TOPIC:
: recent study J Development of a porous poly?D;/lactic acid/co/glycolic acid@/ased scaffold for mastoid air/cell
regeneration= done y +ould TM in the Division of Drug Delivery and Tissue 4ngineering, -niversity of
%ottingham, -niversity 0ar&, %ottingham, -nited Kingdom and pulished in the 7ournal of ;aryngoscope in Dec
"21)B3C. This study related to in vitro development of a temperature/sensitive poly?D;/lactic acid/co/glycolic
acid@Hpoly?ethylene glycol@ ?0;+:H04+@ scaffold for mastoid air/cell regeneration. This study demonstrate similar
structural features to human mastoid one, support cell gro<th, and display sustained antiiotic release. These
scaffolds may e of potential clinical use in mastoid air/cell regeneration. But further in vivo studies are re>uired
to assess the suitaility of 0;+:H04+/alginate scaffolds for this application.
CONCLUSION:
This revie< has oth, summari*ed and critically revie<ed 'hin/ichi Kanemaru article JImprovement of 4ustachian
Tue Function y Tissue/4ngineered Regeneration of (astoid :ir 8ells. The introductory lin&s, structure, strength,
accuracy and relevance of the article <ere analy*ed and criti>ued. This article provides a revie< of the latest
evidence for current treatment strategies,for intractale 8O( y the regeneration of mastoid air cells <ith tissue
engineering methods. :s this the most common cause of significant moridity, and a leading cause of deafness all
over <orld BFC. :lthough regenerated (:8s can perform gas eAchange function in the middle ear and improves
4T function, esides that their function cannot reach the level of normally developed (:8s. It is considered that
mutualistic relationship eAists et<een (:8 function and the 4T.
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