Tympanic membrane regeneration therapy (TMRT) is a regenerative treatment for tympanic membrane perforation that has been covered by japan's national health insurance since november 2019. Concurrently, retympa® (a gelatin sponge containing basic fibroblast growth factor [bfgf]; nobelpharma co., ltd., tokyo, japan) was introduced as a therapeutic agent for tympanic membrane perforation.

TMRT is a simple, minimally invasive procedure with a short operative time that eliminates the need for harvesting and transplantation of autologous tissue. The procedure consists of freshening the perforation margins to activate the regenerative process, placing retympa® as a scaffold containing bfgf, and covering it with fibrin glue. This approach promotes regeneration of a tympanic membrane with a morphology closely resembling that of the normal tympanic membrane.

although TMRT was initially indicated for simple tympanic membrane perforations, its potential application to chronic otitis media and other middle ear diseases is of considerable clinical interest. We therefore extended the concept of TMRT to cases of chronic otitis media conventionally requiring tympanoplasty, an approach we refer to as regenerative tympanoplasty (RTP). Comparative studies of RTP and conventional tympanoplasty (CTP) demonstrated that RTP was associated with a significantly shorter operative time and superior hearing outcomes. These findings suggest that RTP represents not merely a modification of conventional surgical technique, but a fundamentally different therapeutic concept based on regeneration rather than reconstruction.

this regenerative approach may potentially be extended to more complex middle ear conditions, including tympanosclerosis, secondary cholesteatoma, congenital cholesteatoma, and cases requiring ossicular chain reconstruction. Thus, TMRT may provide a foundation for a new approach to middle ear surgery.

because TMRT is based on the principles of regenerative medicine, which differ fundamentally from those of conventional reconstructive surgery, understanding this conceptual distinction is essential for achieving optimal tympanic membrane regeneration and hearing outcomes. This lecture will first address the fundamental differences between tympanic membrane regeneration and tympanic membrane reconstruction. It will then discuss the expanding application of TMRT/RTP to middle ear diseases traditionally treated by conventional tympanoplasty, including chronic otitis media, tympanosclerosis, secondary cholesteatoma, and ossicular chain disorders, and explore how regenerative medicine may transform the future of middle ear surgery.