Application of Platelet Rich Fibrin Matrix to Repair Traumatic Tympanic Membrane Perforations: A Pilot Study

Abstract

Trauma in the form of instrumentation, slap, blast, accident, and sporting injury can result in tympanic membrane (TM) perforations which spontaneously recover in 53-94%. The closure rates of TM perforation due to above causes do not vary greatly; however, some otolaryngologists prefer to perform immediate microsurgical procedures to accelerate the recovery process. Our aim is to study the efficacy of Trichloroacetic acid (TCA) Chemical Cauterization (50%) and Platelet rich fibrin (PRF) Plug Myringoplasty technique in healing traumatic tympanic membrane perforations. To evaluate the preoperative and postoperative hearing outcome from the procedure and compare them. Study design is prospective study. A pilot study was carried out amongst selected 25 patients with central perforations in the Department of ENT, for duration of 2 years from July 13 to July 15. All 25 patients underwent PTA assessment & TCA (50%) and Autologous PRF Plug Myringoplasty technique done and follow up to 6 months postoperatively. The success rate traumatic tympanic membrane closure was found to be 92%. Pre- and post-operative hearing assessments of each patient were done & showed statistically significant air-bone gap closure with success rate of 88% (p < 0.05). From this study, the closure rate in traumatic tympanic membrane perforation by TCA (50%) and PRF Plug Myringoplasty technique was 92% with statistically significant hearing improvement (88%). This technique can be recommended as a time and cost effective office based procedure for treatment of traumatic tympanic membrane perforations.

Keywords: Autologous; Myringoplasty; Platelet rich fibrin.

Fig. 1

Left ear traumatic tympanic membrane perforation

Fig. 2

Bilateral well pneumatized mastoid digital X-ray

Fig. 3

Diagnostic nasal endoscopy to rule out deviated nasal septum and sinusitis

Fig. 4

Pre procedure pure tone audiogram

Fig. 5

Patch test

Fig. 6

Pure tone audiogram after patch test

Fig. 7

Image showing the various layers immediately following centrifuge. Platelet rich fibrin separated and held with a forcep

Fig. 8

Autologous platelet rich fibrin matrix plug myringoplasty technique. a Left ear traumatic tympanic membrane perforation, b 4% xylocaine soaked cotton for local anaesthesia, c 50% trichloroacetic acid application to freshen the margins of the perforation, d and e drawing 10 cc blood to obtain Platelet rich fibrin tube placed in centrifuge, f centrifuge apparatus, set at 2400 rpm for 12 min, g and h Platelet rich fibrin obtained and separated from Red blood cell layer, i Platelet rich fibrin plugging myringoplasty done, j post-procedure oto-endoscopy day 15, k post-procedure oto-endoscopy day 60

Fig. 9

Time to closure of the tympanic membrane using autologous PRF

Fig. 10

Comparison of improvements in ABG averages in perforation using Autologous PRF