Use of gelfoam for grafting traumatic tympanic membrane perforation

ABSTRACT

Many procedures using different materials [e.g. gelfoam] have been tried to close the tympanic membrane perforation in an attempt to enhance and hasten the healing process of the tympanic membrane. To evaluate the results of gelfoam patch in patients with recent traumatic perforations of the tympanic membrane of different sizes. This study was performed on [52] patients with traumatic tympanic membrane perforation in Al-Kadhimiyia Teaching Hospital in Baghdad [from January to December 2007]. The perforations were classified into 4 Grades according to size [GI<25%, GII25-50% or multiple perforations involving 2 quadrants,GIII50-75% or multiple perforations involving 3 quadrants, GIV more than 75%]. After gentle cleansing of the external auditory canal, the perforations were patched with a Gelfoam impregnated with blood taken from the same patient by fine needle aspiration. These patients were followed up at 3 weeks, 6 weeks, and 3 months intervals during which another otological and audiometrical assessment was performed. The closure rates were 100%, 87%, 57% for grades I, II and III perforations respectively. Whereas none of the grade IV perforations were healed. Small perforations needed the least time for closure [average duration was 4.5 weeks], while larger perforations needed longer duration for closure [average duration was 11 weeks]. No correlation was found between closure rate neither with the location of the perforation nor with the age of the patient. Gelfoam patching improves the closure rate of traumatic tympanic membrane perforations. It is technically simple, safe to perform, and suitable as an outpatient procedure and has a good success rate. It is recommended to use this procedure for patients with recent traumatic tympanic membrane perforation especially for small and medium size perforations