Role of trichloroacetic acid and paper patching in closure of tympanic membrane perforations: our experience

Perforations of tympanic membrane are a common cause for seeking otologic consultation, the etiology being infectious, traumatic or iatrogenic. Surgical repair of the tympanic membrane using various types of tissue grafts (e.g. temporalis fascia, perichondrium, cartilage etc.) by various researchers by using various techniques is generally accepted. Surgery however has its own inherent morbidity, besides being expensive and time consuming. Failure rates increase with history of recurrent infections and revision myringoplasty.Considering the above factors, chemical cauterization using TCA of margins of perforation with paper patching of perforation , not only avoids the above mentioned complications, but is cost effective and time saving for both the doctor and the patient. The most widely used chemical for closure is trichloroacetic acid (TCA).The purpose of this study was to report the results of chemical cauterization with TCA and paper patch myringoplasty performed as an out-patient procedure. This study was carried out in a tertiary care hospital ( SHKM GMC NUH, Haryana, India) from november 2017 to june 2018.Patients with small central perforation involving single quadrant of pars tensa not exceeding 4 mm in diameter ( estimated using calipers under microscope) with AB gap < 40 db were selected. Under microscope, the margins of perforation were de-epithelialised with 50% TCA. Cigarette paper patch (pre-sterilized by placing in ethylene oxide gas chamber) was trimmed to provide approximately 1-2 mm overlapping margins along the periphery of the perforation.