09-11, 07:00–07:15 (Europe/Istanbul), Otology 6
Description: Two randomized clinical trials evaluated hyaluronic acid gel (HAG) as an adjunct in middle ear surgery: as a sealing material in primary stapedotomy (150 ears, HAG vs fat) and as middle ear/external canal packing in tympanoplasty for large or subtotal perforations (488 ears, HAG vs absorbable gelatin sponge). In stapedotomy, HAG provided ABG closure ≤20 dB comparable to fat, with more ears achieving ABG ≤10 dB and no sensorineural safety signal. In tympanoplasty, 2.5% HAG significantly improved graft success while maintaining equivalent AAO-HNS hearing outcomes.
Outcome Objectives: After this session, attendees will be able to:
Analyze randomized evidence for HAG versus traditional sealing/packing materials in middle ear surgery.
Compare graft and hearing outcomes using standardized AAO-HNS reporting criteria.
Recognize indications, contraindications, and safety considerations for HAG application.
Implement practical techniques for using HAG as stapedotomy sealant and tympanoplasty packing.
Structure of the session: Didactic lecture with brief literature review, presentation of trial methodology and key results, operative images/video illustrating HAG use, and interactive case-based discussion, followed by audience Q&A on integrating HAG into routine otologic practice.
4 - Background (Key References)
Faramarzi M, Faramarzi A, Roosta S, et al. Hyaluronic Acid Gel as Middle Ear and External Auditory Canal Packing Material in Tympanoplasty. Otolaryngol Head Neck Surg. 2023
Faramarzi M, Roosta S, Aminpour S. Comparing Gelfoam vs Fat as a Sealing Material in Stapedotomy: A Prospective Double-Blind RCT. Clin Otolaryngol. 2019.
Faramarzi M, Roosta S, Faramarzi A, Asadi MA. Comparison of Hearing Outcomes in Stapedotomy with Fat and Hyaluronic Acid Gel as a Sealing Material. Eur Arch Otorhinolaryngol. 2021.
Faramarzi M, Kaboodkhani R, Roosta S, Azarpira N, Shishegar M, Bahranifard H. Application of amniotic membrane for covering mastoid cavity in canal wall down mastoidectomy. Laryngoscope. 2019;129(6):1453-1457.
Faramarzi M, Kaboodkhani R, Faramarzi A, Roosta S, Erfanizadeh M, Hosseinialhashemi M. Mastoid obliteration and external auditory canal reconstruction with silicone block in canal wall down mastoidectomy. Laryngoscope Investig Otolaryngol. 2021;6(5):1188-1195.
To synthesize randomized clinical trial evidence on hyaluronic acid gel (HAG) as a sealing and packing adjunct in middle ear surgery and outline its implications for contemporary otologic practice.
Mohammad Faramarzi, M.D., is a Professor of Otolaryngology–Head and Neck Surgery at Shiraz University of Medical Sciences, Shiraz, Iran. He practices at the Department of Otolaryngology–Head and Neck Surgery, Khalili Hospital, Dastgheib Hospital, and Dena Private Hospital.
He completed his fellowship in Otology and Neuro-otology at Tehran University of Medical Sciences (2001–2003) and later obtained a fellowship in Rhinology and Endoscopic Sinus Surgery at Yazd University of Medical Sciences (2010–2011). He also holds the Iranian national board in otolaryngology (1997) and an M.D. from Shiraz University of Medical Sciences (1990).
Professor Faramarzi’s research focuses on otology and middle ear surgery, including stapedotomy, tympanoplasty, ossicular reconstruction, mastoid surgery, and the use of novel materials in ear surgery. He has also contributed significantly to studies on nasal airway physiology, tonsillectomy outcomes, pediatric otolaryngology, and medical education. He is the author or co-author of more than 90 peer-reviewed publications in international journals, including multiple randomized clinical trials in middle ear surgery.
He has received numerous institutional awards for excellence in teaching from Shiraz University of Medical Sciences and the Department of Otolaryngology over many consecutive years, highlighting his longstanding commitment to resident training and medical education. Through his combined clinical, research, and teaching activities, Professor Faramarzi has played a key role in advancing evidence-based otologic and rhinologic surgery in southern Iran and beyond.