Study of effect of 1% sodium hyaluronate application on tympanic membrane perforation

Dimple Sahni, Bikramjit Singh, K. S. Uppal, Sanjeev Bhagat, Dinesh Sharma, Girish Dogra


Background: Topical applications of hyaluronic acid have been found to have beneficial effects on closure of tympanic membrane perforations. The aim of the study was to evaluate the role of 1% sodium hyaluronate in the repair of small or medium sized dry central tympanic membrane perforation and improvement in hearing following closure of tympanic membrane perforation.

Methods: 50 patients with dry central perforation of inflammatory or traumatic origin were taken up. Maximum of 4 applications of 1% sodium hyaluronate were given at weekly intervals. Final mapping for closure of tympanic membrane perforation and hearing assessment was done after 3 months.  

Results: 26 perforations closed completely while 18 perforations showed significant reduction in size. Thus 44 or 88% perforations showed positive response to 1% sodium hyaluronate application. Hearing Improvement was observed on pure tone audiometry with the average hearing gain in patients after complete closure of tympanic membrane perforation was 12.40 dB with p value of 0.001.

Conclusions: Study showed the beneficial effects of 1% sodium hyaluronate application in closure of small and medium size perforations of tympanic membrane perforation and improvement in hearing.



Hyaluronic acid, Tympanic membrane perforation, Pure tone audiometry, Chemical cautery, Hearing loss

Full Text:



Puleck JL. Disease of tympanic membrane. In: Paparella MM, Shumrick DA, editors Otolaryngology 2nd ed. Otology and Neurology, Philadelphia: WB Saunders Company; 1980: 1381-1401.

Alzahrani M, Saliba I. Hyaluronic Acid Fat Graft Myringoplasty vs Fat Patch Fat Graft Myringoplasty: Eur Arch Otorhinolaryngol. 2015;272(8):1873-7.

Ormerd FC, McLay K. The technique of plastic operations on the sound conducting apparatus. J Laryng Otol. 1956;70:648-63.

Hong P, Bance M, Gratzer PF. ; Repair of tympanic membrane perforation using novel adjuvant therapies: A contemporary review of experimental and tissue engineering studies,2012; Int J Pediatr Otorhinolaryngol. 2013;7:3-12.

The BM, Shen Y, Friedland PL, Atlas DM, Marano JR. A review on the use of hyaluronic acid in tympanic membrane wound healing, 2012; Expert Opin Biol Ther. 2012;12(1):23-36.

Gun T, Boztepe OF, Atan D, Lkinciogullari A, Dere H. Comparison of Hyaluronic Acid Fat Graft Myringoplasty, Fat Graft Myringoplasty and Temporalis Fascia Techniques for the closure of Different Sizes and Sites of tympanic Membrane Perforations, 2016.

Murray Robert K, Keeley Fredrick W. The extracellular matrix. Harper’s Biochemistry, ed 24th.Stamford:Appleton and Lounge Co. 1996:667-685.

Ahn JH, Lim HW, Hong HR. The clinical application and efficacy of sodium hyaluronate- carboxymethylcellulose during tympanomastoid surgery. Laryngoscope. 2012;122(4):912-5.

Baba EIB, Barake C, Roger M, Jurjus R, Sertel S, Jurjus A. Stem Cells in the Management of Tympanic Membrane Perforation: An Update. Neurological Regeneration. 2017: 181-194.

Bali K, Sood VP. Intact canal wall tympanoplasty with mastoidectomy. Ind J Otolaryngol. 1973;25:196.

Paprella MM. Treatment of permanent perforation of tympanic membrane. Otolaryngology Ed. 3 (II),Philadelphia, WB Sunders Co, 1991: 1364.

Stenofars LE. Repair of tympanic membrane perforations using hyaluronic acid: An alternative to myringoplasty. J Laryngol Otol. 1989;103:39-40.

Reijnen CJH, Kuijpers W. The healing pattern of drum membrane. Acta Otolaryngologica 1971;(Suppl 287):1-74.

Dunlap AM, Schuknecht HF. Closure of perforation of tympanic membrane. Laryngoscope (St. Louis) 1947;57:479.