Efficacy of Office-Based 50% Trichloroacetic Acid Chemical Cauterisation for Small Tympanic Membrane Perforations: A Prospective Interventional Study

Abstract

Introduction: Small tympanic membrane perforations may be managed by office-based non-surgical techniques. Chemical cauterisation with trichloroacetic acid (TCA) stimulates healing of perforation margins and may provide an alternative to surgical repair in selected patients. This study evaluated the outcomes and closure rates of office-based 50% TCA chemical cauterisation in small tympanic membrane perforations.

Materials and Methods: This prospective interventional study was conducted from April 2020 to March 2023, at the Department of ENT, National Medical College and Teaching Hospital, Birgunj, Nepal. Fifty-four patients with 58 small, dry central pars tensa perforations were evaluated. To  avoid unit-of-analysis clustering bias, statistical associations were adjusted to the patient level (n=54). Perforation margins were chemically cauterised using 50% TCA via video-endoscopic assistance at weekly intervals for a maximum of 12 sessions without patching. Short term successful closure was assessed two weeks post-treatment.

Results: Among the cohort, complete anatomical closure was achieved in 39 patients, giving an overall success rate of 72.2% (95% CI: 59.8 % – 83.1%). The mean number of weekly treatment sessions required for successful  closure was 4.9 ± 1.8 weeks (Range: 2–10). While traumatic perforations (n=4) all achieved closure, the sample was too small for definitive causal inference. Patients with single-quadrant perforations demonstrated a significantly higher closure rate (80.4 %) compared to those with multi quadrant involvement (25.0 %); Fisher’s Exact Test, p=0.019. No major sensorineural or vestibular complications were encountered.

Conclusion: Office-based chemical cauterization with 50% trichloroacetic acid is a safe, simple, and low-cost alternative for managing small, single quadrant tympanic membrane perforations in resource-limited settings.