Non-surgical approach for repairing perforations of pars tensa in tympanic membrane using TCA cauterization

Abstract

INTRODUCTIONChronic suppurative otitis media is widely found in developing countries like India, Pakistan, Bangladesh and Nepal, mainly occurring in the rural parts of developing countries where healthcare penetration is less. The relative incidence of lesions involving the tympanic membrane has been estimated at 0.4% to 2.3% of all ear diseases. 1 It is attributed as the leading cause for hearing loss in rural India, resulting mainly due to the perforations of the tympanic membrane, as sequelae of untreated acute suppurative otitis media. 2 If treated in time, it is noted that most (88%) of the acute perforations of any size heal without any need for interventions. 3 The unresolved cases lead to development of chronic suppurative otitis media, which result in non-healing chronic perforations in both pars tensa and pars flaccida depending on the type of disease i.e. mucosal or squamosal COM respectively. Perforations occurring due to mucosal COM usually require surgical interventions for repair like myringoplasty or tympanoplasty depending on the size of the central perforation. Perforations occurring in pars flaccida have completely different surgical approaches and were not included in this study. Factors like treatment cost burden and invasiveness of surgical approaches have lead researchers to innovate and investigate simple non-surgical methods to achieve the same results of successful closure of these perforations ABSTRACT Background: Tympanic membrane perforations occurring due to mucosal COM usually require surgical interventions for repair (myringoplasty or tympanoplasty) depending on the size and site of the perforation and the ossicular chain continuity. Various studies have shown TCA cautery as an efficacious non surgical method for repairing small and medium sized TM perforations. This technique was successfully used and popularized for repairing small and medium sized perforations by Derlacki in 1953. Methods: In this study we included dry pars tensa perforations in 100 patients occurring due to trauma or unresolved cases after inflammation/infection of middle ear. 50% w/v trichloro acetic acid was used for a maximum number of 5 applications at the margins of the perforations which were followed up for the next one year. Results: In this study, involving a total of 125 perforations (75 unilateral and 50 bilateral), success rate was high among the patients with traumatic perforations and small sized perforations while a few number of perforations only reduced in size, which were later corrected with surgical approaches (myringoplasty/tympanoplasty). The overall success rate achieved in this study was 72.16%. Conclusions: Though there are various materials and methods available for this procedure, the principle remains the same. This technique should be attempted for patients that fit the criteria for undergoing this procedure before being undertaken for surgical approaches to minimize the risks and cost burden associated with surgery and anesthesia.