Various methods have been described for closure of small tympanic membrane perforations, ranging from paper patching to use of fibrin glue. The procedure needs to be non-invasive and cost effective. Use of Terdermis to close perforations of all sizes has been described in this article. Terdermis has two layers - a collagen layer which is made to slide under the rim of the perforation, the margins of which are freshened. The silicon layer sits on the meatal side of the tympanic membrane, the two layers thus ‘sandwich’ the rim of the perforation and allow the material to be lodged quite stably. After seven days, the outer silicon layer is peeled off and epithelialisation of the eardrum defect is expected to have closed the perforation. The procedure is repeated if tympanic membrane perforation has not closed. The study involved a total of 19 patients. After initial operation, 14 out of 19 perforations closed. Middle and large sized perforations required repeat procedures. The success rate was 0 for perforations which were wet, suggesting the method does not work in cases of extensive otorrhoea, because the sponge acts as an artefact. The procedure takes little time, costs less and does not require post auricular incision. The only disadvantage is that the silicone layer has to be peeled off. The method could be a useful office procedure and comparisons should be made with published results of other such methods.

Clinical study of transcanal closure of tympanic membrane perforations using collagen sponge.
Tamae A, Komune S.
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Madhup K Chaurasia

United Lincolnshire Hospitals NHS Trust; University of Leicester, UK.

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