Effect of Silver Nitrate and Epidermal Growth Factor on Nonhealing Tympanic Membrane Perforations: A Randomized Controlled Study

Abstract Introduction Most tympanic membrane perforations in chronic otitis media require surgical myringoplasty for closure. This study aimed to find out a simple nonsurgical outpatient procedure to close these perforations that could reduce the hospital stay, medical cost, and morbidity in these patients. Materials and Methods The study was conducted in a tertiary referral hospital in a single-blind randomized controlled trial design with two groups, each with a sample size of 40 ears. Only small-size central nonhealing traumatic and chronic otitis media perforations were recruited. Pure tone audiometry and otomicroscopy were performed in all eligible patients who consented to take part in the study. Group 1 was treated with silver nitrate chemical cautery alone. Group 2 received epidermal growth factor gel application in addition to chemical cautery. Both the groups were followed up for a minimum period of 3 months. The same investigations were performed during follow-up. Results and Observations The outcome was considered a success whether there was closure of perforation or reduction in the size of perforation. The success rate of these nonhealing perforations was found to be significantly higher in group 2 (71.42%) than in group 1 (47.36%). Hearing gain was observed in closed perforations of both the groups. Conclusion Epidermal growth factor application enhances the healing effect of silver nitrate in small nonhealing tympanic membrane perforations. The encouraging results of epidermal growth factor have vast applications in improving outcomes of surgical myringoplasty and treatment of residual perforations remaining after the same.

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Effect of Epidermal Growth Factor with Silastic Scaffold on Tympanic Membrane Perforations of Chronic Otitis Media

Annals of Otology and Neurotology ◽

10.1055/s-0041-1735386 ◽

2021 ◽

Author(s):

Vikram Kemmannu Bhat ◽

Suhas Suresh Desai ◽

Darshan Hiremath

Keyword(s):

Growth Factor ◽

Epidermal Growth Factor ◽

Tympanic Membrane ◽

Otitis Media ◽

Nitrate Solution ◽

Chronic Otitis Media ◽

Pure Tone Audiometry ◽

Disease Stage ◽

Tympanic Membrane Perforations ◽

Epidermal Growth

Abstract Aims The burden of chronic otitis media continues to be high, especially in developing countries. The demand for corrective procedure of surgical myringoplasty, which is considered the gold standard for tympanic membrane perforations, is also growing. Hence, there is a need to innovate simpler alternative office procedures that could save effort, time, waiting period, and expenditure. Materials and Methods This prospective study of 84 patients with mucosal chronic otitis media was undertaken in a tertiary referral hospital. All patients underwent eustachian tube function test, diagnostic nasal endoscopy, and pure tone audiometry. The size of the perforation was assessed endoscopically. All perforations were freshened first with silver nitrate solution. Silastic pieces were placed medial and lateral to the perforation with epidermal growth factor gel in between. Patients were followed up for 3 months. Results The perforations were classified into three groups (healed, partially healed, and nonhealed) based on the treatment response at the end of the first and third follow-up months. Completely healed and partially healed perforations were considered as “success” and were found to be 79% in this study. Significant association was found between healing status and type of anesthesia. However, the disease stage, size of perforation, and the duration of procedure did not affect the healing status. Conclusion Silastic enhanced myringoplasty with epidermal growth factor is a simple, effective, and economical procedure that can become an alternative to surgical myringoplasty for chronic otitis media.

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