Supporting Breastfeeding in the Setting of Perinatal Opioid Use Disorder.

Tympanic membrane (TM) regeneration therapy (TMRT) is a regenerative medical treatment for TM perforations (TMPs) that became eligible for health insurance coverage in Japan in 2019 [, , ]. Unlike conventional TM reconstruction procedures such as tympanoplasty, TMRT does not require harvesting and transplanting autologous tissue to close the TMP. This changes the nature of surgical intervention and reduces the risk of postoperative complications due to the size and location of the TMP. In other words, in conventional tympanoplasty (CTP), the difficulty of tissue transplantation varies depending on the size and location of the TMP, affecting postoperative hearing improvement and the likelihood of re‐perforation. However, with TMRT, TM regeneration occurs simply by placing a bFGF‐impregnated gelatin sponge, regardless of the size and location of the perforation, resulting in fewer postoperative problems. Furthermore, the short operative time and regeneration of a TM close to the original TM can significantly improve hearing. However, TMRT generally avoids creating a tympanomeatal flap and preserves the integrity of the TM annulus, which can slightly limit visibility and access when removing intratympanic lesions. Therefore, TMRT has historically been limited to simple TMPs. Meanwhile, for more severe cases of chronic otitis media with TMP, tympanoplasty has been the only treatment available. In this study, to extend the application of TMRT to these severe cases, we preserved the TM annulus and, in principle, removed the remaining TM in all cases to maximize the surgical field. Using an endoscope, we removed lesions (infectious granulation tissue, edematous mucosa, polyps, sclerotic lesions, mucus, etc. in the middle ear associated with chronic otitis media) within the tympanic cavity, followed by high‐pressure irrigation of the tympanic cavity, including the epitympanic area. We then conducted a comparative analysis between patients treated with TMRT using this surgical method and those who underwent conventional tympanoplasty (CTP), and we report the findings here. Since November 2019, when TMRT became covered by National Health Insurance in Japan, 864 patients have undergone TMRT at the two institutions listed below. Of these, 358 patients with chronic otitis media associated with otorrhea or intratympanic lesions, rather than simple TMP, required tympanoplasty. Of these, 101 patients (112 ears, 16–96 years old, 44 males, 57 females) who did not have cholesteatoma and did not require conductive reconstruction were followed up for at least 6 months after surgery and underwent all the prescribed evaluation items; these patients were designated as the TMRT group. In contrast, the control (CTP) group consisted of 53 patients (54 ears, 18–75 years old, 24 males, 29 females) with chronic otitis media and TMP who underwent conventional tympanoplasty at the same two facilities mentioned above between December 2018 and November 2019. Only patients who did not require mastoidectomy or ossicular reconstruction were included in the study. All patients were administered repeated antibiotic ear drops, oral medication, and tympanic cavity irrigation to maintain a tympanic cavity as dry as possible before surgery.