Role of trichloroacetic acid and gelfoam in closure of tympanic membrane perforations

Abstract

Objective: The aim of the study was to study the closure of dry central type of tympanic membrane perforations by chemical cautery and improvement of hearing, to analyse the effect of Gelfoam on nonhealing small tympanic membrane  perforations, and to examine the relevance of conservative means of closure of tympanic membrane perforations as an office procedure.

Materials and Methods: In this study, 100 patients attending the outpatient department were enrolled.  Cautery of perforation margin was carried out with 50% trichloroacetic acid (TCA). After cautery, in small perforations less than 4 mm, a small piece of Gelfoam larger than the size of perforation was cut, impregnated with corticosteroid ointment, and carefully placed over the cauterized area under endoscopic visualization. In slightly larger perforations, that is, between 4 and 5 mm, after applying TCA to the margins of the perforation, a piece of Gelfoam larger than the size of perforation was soaked with corticosteroid ointment and placed in the middle ear cavity.

Results: Patients had relief from various symptoms, such as tinnitus, heaviness, and so on. There was some amount of auditory improvement in almost all the cases. It ranged from 5 to 23 dB.

Conclusions: Cautery and patching of tympanic membrane perforation may be  considered as the first-line management in the small- to medium-sized perforations before attempting the surgical closure.

Keywords: Cautery, Gelfoam, patching, trichloroacetic acid, tympanic membrane perforation