Management of large traumatic TM perforations can involve observation and water precautions or surgical repair. Closure rates for larger perforations can be 8-12 weeks and occurs for between 38-79%. Animal and human studies have shown that exogenous application of epidermal growth factors (EGF) can accelerate the rate of closure. This retrospective study investigated the effects and short-term complications of topical application of EGF and ofloxacin otic drops in human large traumatic TMPs compared with conservative treatment. Three groups of patients were identified: observation only group, EGF-treated, and ofloxacin otic drops. Patients self-selected into these three groups. The growth factor or ofloxacin was applied in drop form once a day by the patient using a technique that involved keeping the ear pointing up for 30 mins after application. Daily treatment was required until the perforation was confirmed to be healed by oto-endosopic examination by a clinician. One hundred and twenty patients were identified, roughly split between the three groups. Closure rates for the ofloxacin drops, EGF and observation only were 93.5%, 92.0% and 82.2%, respectively. The mean perforation closure times were 12.6±6.9, 12.9±5.1 and 35.7±9.2 days for the EGF, ofloxacin and observation groups, respectively. The average closure time in the observation group was significantly longer (p=0.01) than that in the EGF and ofloxacin otic drops groups. However, the closure times in the EGF and ofloxacin otic drops groups were not significantly different. Seventy percent of the perforations reached complete closure within two weeks in two treatment groups versus only 22.2% in the observation group. Patients were followed up over six months. Outpatient therapeutic myringoplasty has significant cost implications in addition to potentially less inconvenience for patients. The authors recommend that ofloxacin drops should be considered in certain clinical cases of traumatic perforation as an alternative to surgical repair or observation alone. 

A retrospective study of EGF and ofloxacin drops in the healing of human large traumatic eardrum perforation.
Yang J, Lou Z-H, Fu Y, Lou Z-C.
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Rohit Verma

North West Deanery, UK.

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