Office myringoplasty by chemical cauterization and paper patching: a prospective study

Authors

  • Garima Upreti Department of ENT, Army College of Medical Sciences and Base Hospital, Delhi, India

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20184677

Keywords:

Tympanic membrane perforation, Myringoplasty, Chemical cautery, Trichloroacetic acid, Paper patching

Abstract

Background: Surgery for tympanic membrane perforation entails its own morbidity, risk of anesthesia, psychological trauma, along with long waiting periods for patients, especially in a tertiary care centre like ours. The purpose of this study was to evaluate outcomes of chemical cauterization and patching of perforation, performed as an office procedure in select cases.

Methods: The study was conducted in a tertiary hospital from January 2016 to December 2017. The patients were selected based on the inclusion criteria, after thorough clinical assessment, examination under microscope and pure tone audiogram. All cases underwent cauterization of margins of perforation using 10% trichloroacetic acid (TCA), followed by patching with appropriately sized pre-sterilized cigarette paper patch. The patients were followed up weekly till the perforation was completely healed or till 12 weeks. If required, the procedure was repeated.  

Results: 68 cases were included in the study. Most common site of perforation was antero-inferior quadrant of pars tensa. Most common etiology was inflammatory. Number of applications ranged from 1 to 3. The procedure was successful in 62 cases (91.2%). All cases with traumatic perforation, residual perforation post-surgery and persistent perforation after grommet extrusion healed well. All 6 cases with treatment failure had inflammatory etiology, 4 involving postero-superior quadrant.

Conclusions: In patients with small, central, dry perforation of tympanic membrane, chemical cauterization using TCA and paper patching can yield results comparable to that of surgery, while abating the morbidity and psychological trauma of surgery and saving time for both patient and doctor.

Author Biography

Garima Upreti, Department of ENT, Army College of Medical Sciences and Base Hospital, Delhi, India

SENIOR RESIDENT ,

DEPARTMENT OF E.N.T.'

ARMY COLLEGE OF MEDICAL SCIENCES & BASE HOSPITAL,

DELHI , INDIA

References

Sergi B, Galli J, De Corso E, Parrilla C, Paludetti G. Overlay versus underlay myringoplasty: report of outcomes considering closure of perforation and hearing function. Acta Otorhinolaryngol Ital. 2011;31(6):366–71.

Berger G, Ophir D, Berco E, Sadé J. Revision myringoplasty. J Laryngol Otol. 1997;111(6):517–20.

Goldman NC. Chemical closure of chronic tympanic membrane perforations. ANZ J Surg. 2007;77(10):850–1.

Juers AL. Office closure of tympanic perforations – Passe? Laryngoscope. 1968;78:756–8.

Derlacki EL. Repair of central perforations of tympanic mem- brane. Arch. Otolaryngol. 1953;58:405–20.

Golz A, Goldenberg D, Netzer A, Fradis M, Westerman ST, Westerman LM, et al. Paper patching for chronic tympanic membrane perforations. Otolaryngol Head Neck Surg. 2003;128(4):565-70.

Dunlap AM, Schuknecht HF. Closure of perforations of the tym-panic membrane. Laryngoscope. 1947;57:479–90.

Maria PLS, Oghalai JS. Is office-based myringoplasty a suitable alternative to surgical tympanoplasty? Laryngoscope. 2014;124(5):1053–4.

Dursun E, Dogru S, Gungor A, Cincik H, Poyrazoglu E, Ozdemir T. Comparison of paper-patch, fat, and perichondrium myringoplasty in repair of small tympanic membrane perforations. Otolaryngol - Head Neck Surg. 2008;138(3):353–6.

Lee SH, Jin SM, Lee KC, Kim MG. Paper-patch myringoplasty with CO2laser for chronic TM perforation. Eur Arch Oto-Rhino-Laryngol. 2008;265(10):1161–4.

Park SN, Kim HM, Jin KS, Maeng JH, Yeo SW, Park SY. Predictors for outcome of paper patch myringoplasty in patients with chronic tympanic membrane perforations. Eur Arch Oto-Rhino-Laryngology. 2013;272(2):297–301.

Kotecha B, Fowler S, Topham J. Myringoplasty: A prospective audit study. Clin Otolaryngol Allied Sci. 1999;24(2):126–9.

Halle TR, Todd NW, Fainberg J. Iatrogenic trichloroacetic acid injury causing necrotizing otitis media and deafness. Int J Pediatr Otorhinolaryngol. 2017;97:139–42.

Lee DH, Kim J, Shin E, Kim Y, Cho Y. Clinical analysis of paper patch myringoplasty in patients with tympanic membrane perforations. J Int Adv Otol. 2016;12(2):142–6.

Pribitkin EA, Handler SD, Tom LW, Potsic WP, Wetmore RF. Ventilation tube removal. Indications for paper patch myringoplasty. Arch Otolaryngol Head Neck Surg.1992;118(5):495-7.

Santhi T, Rajan KV. A Study of Closure of Tympanic Membrane Perforations by Chemical Cauterisation. Indian J Otolaryngol Head Neck Surg. 2012;64(4):389–92.

Stroud M. Office myringoplasty.. The Laryngoscope 1985; 95(12): 1549-50.

Camnitz PS, Bost WS. Traumatic perforations of the tympanic membrane: Early closure with paper tape patching. Otolaryngol- Head Neck Surg. 1985;93(2):220–3.

Lou ZC, He JG. A randomised controlled trial comparing spontaneous healing, gelfoam patching and edge-approximation plus gelfoam patching in traumatic tympanic membrane perforation with inverted or everted edges. Clin Otolaryngol. 2011;36(3):221–6.

Downloads

Published

2018-12-25

Issue

Section

Original Research Articles