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<p>Tympanic membrane perforations can reduce hearing and increase the risk of repeated middle ear infections or a cholesteatoma. Traditional surgical repair (Myringoplasty), often using temporalis fascia or cartilage grafts, is effective but requires general anaesthesia, an operating room, and a longer recovery time. In contrast, newer office-based procedures that use chemical agents or biological scaffolds provide accessible, lower-risk alternatives to surgery. In this study, we report our outcomes of the non-surgical office-based technique using Trichloroacetic Acid (TCA) chemical cautery combined with an autologous Platelet-Rich Fibrin (PRF) sheet for the repair of small, central, dry tympanic membrane perforations. To evaluate the anatomical closure, hearing improvement, and safety of combined TCA and PRF therapy in the management of small tympanic membrane perforations. This prospective single-arm study included 70 patients with small, dry tympanic membrane perforations treated at a tertiary care hospital. Following chemical cauterization of the perforation margins with 20% TCA, an autologous PRF sheet was applied over the perforation under otoendoscopic guidance. The procedure was repeated weekly for a maximum of four applications. Patients were followed weekly for four weeks to assess anatomical closure, and pure tone audiometry was performed one month after documented closure. Hearing outcomes were analysed using the Wilcoxon signed-rank test, while categorical variables were compared using the Chi-square test. A p-value &lt; 0.05 was considered statistically significant. Complete tympanic membrane closure was achieved in 61 of 70 patients, resulting in an overall success rate of 87.1% (95% CI: 77.3%–93.1%). The mean air–bone gap improved significantly from 27.94 ± 1.36 dB preoperatively to 15.77 ± 3.74 dB postoperatively, with a mean improvement of 12.17 ± 4.71 dB (95% CI: 11.05–13.30 dB; <i>p</i> &lt; 0.001). Perforation site was significantly associated with treatment success (<i>p</i> = 0.0019), whereas gender, laterality, and aetiology showed no significant association (all <i>p</i> &gt; 0.05). Only minor, self-limiting complications were observed. Combined TCA and PRF therapy demonstrated promising short-term anatomical and functional outcomes in patients with small tympanic membrane perforations. The technique is minimally invasive, safe, and suitable as an office-based procedure for selected patients. However, the absence of comparator groups and the short follow-up period limit conclusions regarding long-term efficacy and comparative effectiveness. Larger randomized controlled studies with longer follow-up are warranted.</p>

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Efficacy of Combined Trichloroacetic Acid and Platelet Rich Fibrin Therapy in Promoting Closure of Small Tympanic Membrane Perforations

  • 期刊论文

  • 发表日期：

    2026年8月1日

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  • Tejashri Shivaji Aher,
  • Ashish S. Totawar,
  • Jeffy Roy Mathew

摘要

Tympanic membrane perforations can reduce hearing and increase the risk of repeated middle ear infections or a cholesteatoma. Traditional surgical repair (Myringoplasty), often using temporalis fascia or cartilage grafts, is effective but requires general anaesthesia, an operating room, and a longer recovery time. In contrast, newer office-based procedures that use chemical agents or biological scaffolds provide accessible, lower-risk alternatives to surgery. In this study, we report our outcomes of the non-surgical office-based technique using Trichloroacetic Acid (TCA) chemical cautery combined with an autologous Platelet-Rich Fibrin (PRF) sheet for the repair of small, central, dry tympanic membrane perforations. To evaluate the anatomical closure, hearing improvement, and safety of combined TCA and PRF therapy in the management of small tympanic membrane perforations. This prospective single-arm study included 70 patients with small, dry tympanic membrane perforations treated at a tertiary care hospital. Following chemical cauterization of the perforation margins with 20% TCA, an autologous PRF sheet was applied over the perforation under otoendoscopic guidance. The procedure was repeated weekly for a maximum of four applications. Patients were followed weekly for four weeks to assess anatomical closure, and pure tone audiometry was performed one month after documented closure. Hearing outcomes were analysed using the Wilcoxon signed-rank test, while categorical variables were compared using the Chi-square test. A p-value < 0.05 was considered statistically significant. Complete tympanic membrane closure was achieved in 61 of 70 patients, resulting in an overall success rate of 87.1% (95% CI: 77.3%–93.1%). The mean air–bone gap improved significantly from 27.94 ± 1.36 dB preoperatively to 15.77 ± 3.74 dB postoperatively, with a mean improvement of 12.17 ± 4.71 dB (95% CI: 11.05–13.30 dB; p < 0.001). Perforation site was significantly associated with treatment success (p = 0.0019), whereas gender, laterality, and aetiology showed no significant association (all p > 0.05). Only minor, self-limiting complications were observed. Combined TCA and PRF therapy demonstrated promising short-term anatomical and functional outcomes in patients with small tympanic membrane perforations. The technique is minimally invasive, safe, and suitable as an office-based procedure for selected patients. However, the absence of comparator groups and the short follow-up period limit conclusions regarding long-term efficacy and comparative effectiveness. Larger randomized controlled studies with longer follow-up are warranted.