Paper-patch myringoplasty with CO2 laser for chronic TM perforation

Abstract

Chronic tympanic membrane (TM) perforations are a common problem in otolaryngology. However, there are controversies of how best to treat TM perforation. Recently, we successfully managed TM perforation with paper patch after trimming the perforated TM margin with the CO2 laser. The purpose of this report is to demonstrate the trial of this method and effectiveness. The authors conducted a retrospective case series from March 2000 to January 2005. Ninety patients underwent paper-patch myringoplasty with the CO2 laser. The procedure was performed in an office setting under local anesthesia. We investigated perforation size and postoperative success rate. Successful closure of the TM was achieved in 52.2% of cases (47/90) without any severe complication. The procedure was successful in 16 of 19 (84.2%) cases in perforation smaller than 2 mm, 19 of 29 (63.0%) cases when the size was 2-4 mm, 10 of 25 (40.0%) cases when the size was 4-6 mm, and 2 of 17 (11.8%) cases when the size was > or =6 mm. A significant difference was found: Perforation with <4 mm had the higher closure rate (chi2 test, P < 0.01). There was no correlation between the size of perforation and the number of patch graft (chi2 test, P > 0.05). The results showed paper-patch myringoplasty after CO2 laser trimming is simple and safe to perform, and suitable as an outpatient procedure, especially in small perforations (<4 mm).

Clinical Analysis of Paper Patch Myringoplasty in Patients with Tympanic Membrane Perforations

“…Our success rate is similar to or slightly higher than those in previous reports [1,2,4] . However, our general success rate is lower than that reported by Lou et al [6] In their study, almost 98% of 504 cases with traumatic TM perforations were acute onset (within 1 month after a trauma), and a spontaneous healing rate of 89% cases was reported.…”

“…Golz et al [1] reported that the closure rate of paper patch myringoplasty depended on the perforation size in the cases of chronic perforations of more than 1 year. Lee et al [2] also reported that TM perforations of less than 4 mm show the highest closure rate, significantly in cases of chronic otitis media. However, these two studies analyzed only the size of TM perforation as the outcome predictor and did not evaluate any other clinical factors.…”

“…Long-standing TM perforations may cause conductive hearing loss and middle ear infection even if they are small. The purpose of the closure of TM perforations is to restore the continuity of the TM to improve hearing ability and decrease the risk of middle ear infection [1][2][3][4] . Although many reports have demonstrated that numerous cases of perforated TM heal spontaneously, several operative interventions can be helpful, particularly for large-sized and peripherally-located perforations [2,4] .…”

“…Golz et al [1] evaluated only chronic perforations of more than 1 year regardless of the cause and followed up the cases until 18 weeks; they recommended paper patching as the first treatment option for TM perforations smaller than 5 mm. Lee et al [2] evaluated only chronic otitis media and followed up the cases through five trials of paper patching; they reported that TM perforations of less than 4 mm had significantly higher closure rates. However, these two studies did not include other clinical factors apart from the size of TM perforations as outcome predictors.…”

Efficacy of Platelet-Rich Plasma on Fat Grafts in the Repair of Tympanic Membrane Perforations: An Experimental Study

“…Longstanding tympanic membrane perforations may cause hearing loss and middle ear infection, even if they are small in size. Although regeneration and the healing abilities of the tympanic membrane have been shown, chronic perforations are widespread, and there is a need to use grafts to repair them [16] . Ringenberg [4] was the first surgeon to use fat tissue at myringoplasty in 1962.…”