The behavior of alloplastic tympanic membranes in Staphylococcus aureus-induced middle ear infection. II. Morphological study of epithelial reactions.

Epithelial reactions to Silastic, Estane polyether urethane, polypropylene oxide, and a poly(ethylene oxide hydantoin) and poly(tetramethylene terephthalate) segmented polyether polyester copolymer were investigated after implantation in tympanic membranes and submucosa of noninfected and Staphylococcus aureus-infected rat middle ears. Porous implants made of Estane and polypropylene oxide were completely covered by tympanic-membrane connective tissue, epidermis, and epithelium in 2 weeks and those made of copolymer in between 2 and 4 weeks postoperatively. Silastic implants, which were dense, were not enveloped by tympanic-membrane tissue but rejected. Starting in the 6th postoperative month the proliferative activity and structure of both the tympanic membrane epithelium and epidermis became normal except for the presence of iron-containing secretory epithelium near polypropylene oxide. After initial swelling caused by the surgical trauma, neither the proliferative activity nor the composition of the epithelium covering submucosal implants was affected by the presence of any of the biomaterials. Infection of middle ears bearing implants induced epithelial reactions similar to those associated with infected middle ears without an implant.