In-Office Paper Patch Placement for Tympanic Membrane Perforation

To evaluate the effectiveness of office-based paper patch myringoplasty in closing chronic tympanic membrane (TM) perforations and identify prognostic factors influencing closure outcomes.

Retrospective chart review between 2016 and 2022.

Tertiary neurotology clinic.

A total of 161 patients with 204 chronic (>6 mo), dry, and small (<50%) TM perforations.

The procedure involved applying 25% trichloroacetic acid to the edges of the perforation, freshening of the perforation edge with a hook, and placing a sterile paper patch under microscopic guidance with a drop of topical ofloxacin on the paper.

Closure rates were assessed after 8 weeks of the procedure. Closure was assessed by otomicroscopy and tympanometry at follow-up visits. Factors associated with closure were analyzed using univariate and multivariable logistic regression, with significance set at P <0.05.

By the 8-week follow-up, Complete and partial healing were observed in 59.8% (122) and 12.7% (26) of patients, respectively. Significant predictors of healing included smaller perforation size ( P =0.001), anterior or superior location ( P <0.001), and younger age ( P <0.005). No complications were reported based on patient self-reports or clinical examination.

Paper patch myringoplasty is a safe and effective outpatient technique for managing chronic, dry TM perforations <50% in size. Healing outcomes are significantly influenced by the size and location of perforations, as well as age. These findings highlight the importance of careful patient selection and support broader use of this low-cost, minimally invasive approach in appropriately selected cases.