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Tympanic membrane (TM) perforations can affect people’s quality of life due to recurrent infections. Management is often by surgical repair. In this study, the authors investigated the outcomes of a minimally invasive approach of patch myringoplasty using an atelocollagen sponge and platelet-rich plasma (PRP) for the closure of chronic TM perforations. They also examined factors potentially affecting surgical outcome. The authors retrospectively reviewed the medical charts of 118 patients with persistent TM perforations undergoing myringoplasty under local anaesthesia over five years. Terdermis® was the atelocollagen/silicone bilayer membrane used as the scaffold. PRP, obtained from double centrifugation of patient’s blood, was injected into the sponge side of Terdermis®. PRP contains growth factors which promote wound healing. Outcome was evaluated in terms of closure rates at two months’ follow-up. If the perforation was smaller after surgery, the procedure was repeated until the perforation was closed completely. The overall success rate of closure after one or more surgeries was 95.8% (68/71) for small perforations, 80% (32/40) for medium perforations and 85.7% (6/7) for large perforations; 70.6% (48/68) of small perforations were closed by single surgery whereas multiple surgeries were required for medium and large perforations. Number of re-operations required for closure significantly increased with perforation size. The chances of successful closure decreased with increasing age.

Cause and duration of perforation were not predictors of outcome.

The authors present a myringoplasty technique with satisfactory results. It would be a useful adjunct to an otolaryngologist’s minimally invasive surgical repertoire. Patients should, however, be counselled about the potential need for multiple surgeries. Availability of blood centrifugation and cost of the Terdermis® are additional considerations. Butterfly tragal cartilage tympanoplasty is a suitable alternative in small perforations and it can often be done using permeatal approach under local anaesthesia without additional synthetic material or equipment.

Surgical outcomes of myringoplasty using platelet-rich plasma and evaluation of the outcome-associated factors.
Shiomi Y, Shiomi Y.
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Praneta Kulloo

Lewisham and Greenwich NHS Trust, UK.

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