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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT06260618
Registration number
NCT06260618
Ethics application status
Date submitted
31/01/2024
Date registered
15/02/2024
Titles & IDs
Public title
Effect of Chitodex Gel in Tympanoplasty Surgery
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Scientific title
A Single-blinded Randomised Trial Evaluating the Efficacy of Chitosan-dextran (Chitodex) Gel Versus Gelfoam Sponge Instillation Within the Middle Ear and External Auditory Canal During Tympanoplasty Surgery
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Secondary ID [1]
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2021/HRE00065
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Tympanic Membrane Perforation
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Tympanic Membrane Inflammation
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Surgery
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Otitis Media
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Condition category
Condition code
Ear
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Other ear disorders
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Infection
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Other infectious diseases
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Infection
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Studies of infection and infectious agents
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Injuries and Accidents
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Other injuries and accidents
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Treatment: Devices - Gelfoam
Treatment: Devices - Chitodex
Active comparator: Gelfoam Arm - The current standard of care in middle ear packing material has been Gelfoam, Gelfoam is an absorbable gelatin sponge manufactured from denatured porcine skin. Generally, Gelfoam resides within the middle ear for 2 to 9 weeks prior to being degraded via phagocytosis.
A single Gelfoam sponge is divided into small pieces and used within the ear. One piece of Gelfoam can typically be cut into over 200 smaller pieces. The surgeon uses approximately 10 to 20 of these smaller pieces per surgery. Approx a third of the product is applied into the middle ear, as a support material for the graft. After graft suturing is complete, the remaining two thirds are applied into the external ear canal as a packing agent.
The surgeon administers the foam during the surgery as they would with the standard TMP repair surgery. The product comes in a sterile package to be opened and cut up by Scrub Nurse.
Experimental: Chitodex Arm - Chitosan-dextran gel is packaged within a syringe and has a cannula attached, much like the Gelfoam syringe system. Approx 3-5mL of product is applied during the surgery. Approx 2mL into the middle ear, as a support material for the graft. After graft suturing is complete, another 3mL (approx) is applied into the external ear canal as a packing agent. This is the same procedure as Gelfoam is currently used for this purpose.
The surgeon will administer the gel during the surgery as they would with the standard of care Gelfoam. The product comes in a sterile kit to be opened by Scrub Nurse.
Treatment: Devices: Gelfoam
GELFOAM Sterile Compressed Sponge is a medical device intended for application to bleeding surfaces as a hemostatic. It is a water-insoluble, off-white, nonelastic, porous, pliable product prepared from purified porcine skin, Gelatin USP Granules and Water for Injection, USP. It may be cut without fraying and is able to absorb and hold within its interstices, many times its weight of blood and other fluids.
Treatment: Devices: Chitodex
The Chitogel Endoscopic Sinus Surgery Kit contains components and equipment for the preparation of a nasal gel to be applied to the sinus cavities via a supplied and specifically designed malleable cannula.
The Gel preparation will take approximately 30 minutes, so preparation must start sufficiently in advance of when the Gel is expected to be used in surgery.
Once the Gel has been prepared it should be applied to the sinus cavities on both sides within six hours using the malleable cannula supplied with the Kit.
The Gel must be prepared on a sterile surface following these instructions. There are two main components to the Gel.
1. Dextran Aldehyde (B), which is a dry powder, and is reconstituted into a liquid form through mixing the powder with a liquid Sodium Phosphate Buffer (A). Both of these components are supplied sterile.
2. The second component Chitosan Succinamide (C), is a liquid and is also supplied sterile.
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Intervention code [1]
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Treatment: Devices
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Number of participants with tympanic membrane closure
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Assessment method [1]
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tympanic membrane closure will be assessed via otoscopy (images will be captured via the otoscopic equipment)
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Timepoint [1]
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Pre-operatively, and 2 weeks, 6 weeks, 3 months and 6 months post-operatively
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Primary outcome [2]
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rate of tympanic membrane closure
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Assessment method [2]
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Time taken for tympanic membrane to close, assessed by otoscopy (images will be captured via the otoscopic equipment)
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Timepoint [2]
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Pre-operatively, and 2 weeks, 6 weeks, 3 months and 6 months post-operatively
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Secondary outcome [1]
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Number of participants with improved hearing
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Assessment method [1]
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An audiogram will be used for assessment of hearing. It measures hearing thresholds in decibels over a range of noise frequencies from 200Hz up to 8000Hz. It is always performed in a sound-proof room with over ear headphones
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Timepoint [1]
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Pre-operatively, and 2 weeks, 6 weeks, 3 months and 6 months post-operatively
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Secondary outcome [2]
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Number of participants with improved eardrum function
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Assessment method [2]
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Eardrum function will be tested by Tympanometry, which tests how well the eardrum moves. The audiologist will put a small probe into the ear. A small device attached to the probe will push air into the ear. The output from the probe is translated to a graph called a tympanogram.
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Timepoint [2]
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Pre-operatively, and 3 months and 6 months post-operatively
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Secondary outcome [3]
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Ease of use of product compared to active comparator - surgeon feedback
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Assessment method [3]
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Ease of use of product will be assessed via surgeon's feedback
The ease of which to place the packing material within the anterior mesotympanum will be assessed, as well as the ease with which adequate graft positioning was obtained at the end of surgery. This will be done on a 7-point Likert scale with 1 been very difficult and 7 being very easy to use. After the surgeon has finished the surgery, the trial staff will collect this score from the surgeon within 24 hours of the surgery.
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Timepoint [3]
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Once, on day of surgery (within 6 hours post-operatively)
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Secondary outcome [4]
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Time taken to complete surgery
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Assessment method [4]
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Start and finish times for all surgeries is clocked into the hospital peri-operative software by the nursing staff in real time. This is a routine part of modern peri-operative care. These records can be retrieved to establish the total operating time of each surgery.
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Timepoint [4]
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Once, for the duration of the operation (hours)
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Secondary outcome [5]
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Number of Participants with improved quality of life
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Assessment method [5]
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This will be determined by a participant subjective symptom score/questionnaire, called the Modified Chronic Otitis Media Outcomes Test (modCOMOT-8 test).
This is a modified/shorter version of a validated test that was designed for the current study, as there is no current validated questionnaire to assess post-tympanoplasty subjective symptoms, The original test, The Chronic Otitis Media Outcomes Test (COMOT-15 test) has been published widely.
The modCOMOT-8 test includes a score for (left and right); hearing, ear discharge, ear pain, ear fullness, tinnitus (ringing in the ears), vertigo, overall ear health, overall impact on quality of life. The total possible score ranges from 0 to 160, where the lower the score, the better the outcome.
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Timepoint [5]
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Pre-operatively, and 2 weeks, 6 weeks, 3 months and 6 months post-operatively
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Eligibility
Key inclusion criteria
1. Individuals who have otoscopic evidence of tympanic membrane perforation that is also confirmed by tympanometry (Defined as a Type B tympanogram, with elevated EAC volume) AND
2. The TM perforation is associated with at least 15dB of conductive hearing loss on the affected side AND
3. Are indicated to undergo closure of the perforation via tympanoplasty surgery AND
4. Demonstrate healthy, dry middle ear mucosal cavities at time of surgery AND
5. Are 18 years of age or over AND
6. Are able to give written informed consent AND
7. Are committed to returning for post-operative assessments at 2 and 6 weeks post-op, 3-, and 6- months post-op
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
1. Operative ear is the better or only hearing ear
2. The ear has evidence of cholesteatoma or other middle ear tumour during otoscopic examination
3. dysfunction during otoscopic and tympanometric examination
4. Known allergy to shellfish or ciprofloxacin antibiotics
5. Pregnant or breastfeeding
6. Hepatitis, HIV or any blood disorders
7. COVID-19 positive patients
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
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Intervention assignment
Parallel
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Other design features
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Phase
NA
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Recruiting
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
20/11/2021
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
13/05/2024
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Actual
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Sample size
Target
44
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
SA
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Recruitment hospital [1]
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The Queen Elizabeth Hospital - Adelaide
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Recruitment hospital [2]
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The Memorial Hospital - North Adelaide
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Recruitment postcode(s) [1]
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5011 - Adelaide
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Recruitment postcode(s) [2]
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5006 - North Adelaide
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Funding & Sponsors
Primary sponsor type
Government body
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Name
Central Adelaide Local Health Network Incorporated
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Address
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Country
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Other collaborator category [1]
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Other
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Name [1]
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University of Adelaide
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Address [1]
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Country [1]
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Ethics approval
Ethics application status
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Summary
Brief summary
The general purpose of this study is to compare Chitosan-dextran (Chitodex) gel versus current standard of care, Gelfoam, as a middle ear (ME) and external auditory canal (EAC) packing agent as part of tympanoplasty procedures to close tympanic membrane perforations (TMP).
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Trial website
https://clinicaltrials.gov/study/NCT06260618
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Prof Peter-John Wormald, MD
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Address
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Central Adelaide Local Health Network
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Country
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Phone
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Fax
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Email
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Contact person for public queries
Name
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Prof Peter-John Wormald, MD,
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Address
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Country
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Phone
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+61 8 82227158
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
No documents have been uploaded by study researchers.
Results not provided in
https://clinicaltrials.gov/study/NCT06260618