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DOI 10.1007/s00405-013-2860-y
OTOLOGY
Received: 17 October 2013 / Accepted: 4 December 2013 / Published online: 10 December 2013
Springer-Verlag Berlin Heidelberg 2013
S.-N. Park H.-M. Kim K.-S. Jin J.-H. Maeng S.-W. Yeo
S.-Y. Park (&)
Department of Otorhinolaryngology-Head and Neck Surgery,
The Catholic University of Korea College of Medicine,
222 Banpo-daero, Seocho-gu, Seoul 137-701, Korea
e-mail: sypak@catholic.ac.kr
Introduction
Acute traumatic perforations of the tympanic membrane
(TM) have long been treated with paper patching methods,
which showed high closure rates [13]. On the other hand,
controversies often exist about how to treat small chronic
TM perforations without middle ear pathology. Some
otologists prefer paper patching, while others prefer surgical myringoplasty using fat or fascia. Chronic TM perforations are caused by acute or chronic otitis media,
trauma, ventilation tube removal, iatrogenic complications
and others. Although the TM has an ability to regenerate in
acute perforations, the natural healing process does not
occur in some cases due to repeated infection with prolonged otorrhea, large perforation size, atrophic TM,
adjacent myringosclerosis, and defective unknown stimulus factors for the repair. It has been reported that three
principles are required for the office repair of TM perforations: the edges should be everted and de-epithelialized;
inflammatory response should be created by chemical or
mechanical irritants to promote epithelial proliferation;
materials laid over the perforation provide a scaffold to
support epithelial migration [4].
In the previous clinical studies, paper patch myringoplasty for chronic TM perforations has achieved successful
healing in 30 % [5], 55.7 % [6], 66.7 % [7], and 52.2 % [8]
with different methodologies. However, the studies on the
factors that may influence the outcome of this procedure
for chronic perforations have been limited to the perforation size [69], location of the perforations, the time the
perforation has been present, and the age of the patients [6].
The purpose of this study was to evaluate the outcome of
paper patch myringoplasty performed in patients with
chronic TM perforations and to explore the predictive
factors for a successful closure of the perforation.
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298
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Results
The patients who met the inclusion criteria were 43 (30
women and 13 men; aged 1581 years; mean age
49.2 13.9). They underwent paper patch myringoplasty
in 18 right and 25 left ears. Patients chief complaints were
hearing impairment, otorrhea, aural fullness, or tinnitus. In
all cases, the perforations were in the pars tensa. Complete
closure was achieved in 27 patients, and the overall success
rate was 62.8 %. All clinical factorsage, sex, the affected
ear, PTA, duration, and causesshowed no significant
difference between the success and failure groups
(Table 1). Of the five PAI selected for determination of
size criterion, only 5 % PAI was significantly associated
with the outcomes. The patients with PAI B5 % showed
higher closure rate (78.3 %) than those with PAI [5 %
(45.0 %) (Table 2). In addition, the mean PAI was significantly lower in the success group (5.6 8.1 %) than in
the failure group (9.7 8.8 %). Among the other TM
factors, posterior perforation, perforation away from the
malleus, perforation with dry TM surface, and multiple
patch applications showed higher closure rates, but there
was no statistical significance (Table 3). Multivariable
299
Failure
(n = 16)
p value
47.5 14.2
51.9 13.2
0.145
23 (63.9)
13 (36.1)
1.000
Failure
(n = 16)
p value
Age
C65 years (n = 7)
4 (57.1)
3 (42.9)
Female (n = 30)
8 (61.5)
19 (63.3)
5 (38.5)
1.000
11 (36.7)
Left (n = 25)
11 (61.1)
16 (64.0)
7 (38.9)
0.847
9 (36.0)
2 (22.2)
14 (41.2)
0.446
B2.5 % (n = 18)
14 (77.8)
4 (22.2)
[2.5 % (n = 25)
13 (52.0)
12 (48.0)
0.084
B5 % (n = 23)
18 (78.3)
5 (21.7)
[5 % (n = 20)
9 (45.0)
11 (55.0)
24 (70.6)
10 (29.4)
3 (33.3)
6 (66.7)
25 (64.1)
14 (35.9)
2 (50.0)
2 (50.0)
0.024*
PAI = 10 %
Hearing
PTA (dB)
7 (77.8)
20 (58.8)
PAI = 5 %
Affected ear
Right (n = 18)
B1 % (n = 9)
[1 % (n = 34)
PAI = 2.5 %
Sex
Male (n = 13)
PAI = 1 %
28.2 24.9
30.0 12.7
0.152
B10 % (n = 34)
[10 % (n = 9)
15.4 11.1
17.0 9.7
0.345
18 (75.0)
6 (25.0)
0.063
9 (47.4)
10 (52.6)
3 months to 1 year (n = 9)
8 (88.9)
1 (11.1)
C1 year (n = 34)
19 (55.9)
15 (44.1)
PAI = 20 %
B20 % (n = 39)
[20 % (n = 4)
Duration
0.121
0.058
0.621
Cause
Chronic otitis media
(n = 30)
19 (63.3)
11 (36.7)
8 (61.5)
5 (38.5)
1.000
Table 3 Tympanic membrane factors: success versus failure groups
Success
(n = 27)
Failure
(n = 16)
p value
Anterior (n = 37)
22 (59.5)
15 (40.5)
0.386
Posterior (n = 6)
5 (83.3)
1 (16.7)
5.6 8.1
18 (78.3)
PAI [5 % (n = 20)
9 (45.0)
11 (55.0)
Location
Perforation size
23 (67.6)
11 (32.4)
4 (44.4)
5 (55.6)
0.257
Surface of TM
Dried-up (n = 19)
14 (73.7)
5 (26.3)
13 (54.2)
11 (45.8)
0.189
Discussion
In the present study, the authors intended to report the
success rate of paper patch myringoplasty for chronic TM
perforations in our clinic and to explore the predictors for
Single (n = 28)
16 (57.1)
12 (42.9)
Multiple (n = 15)
11 (73.3)
4 (26.7)
0.295
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