Effectiveness of Silver Nitrate Cauterization vs Conservative Management in Tympanic Membrane Perforation Closure

Tympanic membrane perforation is a common clinical condition resulting primarily from middle ear infections or trauma. While small perforations can heal spontaneously, active intervention may be required to accelerate healing and prevent chronic complications. In this quasi-experimental comparative study conducted at the Department of Otorhinolaryngology, Rawalpindi Teaching Hospital, eligible participants aged 18 to 60 years with small, dry, unilateral pars tensa perforations are allocated into two groups based on clinical observation and patient preference: Intervention Group (Group A): Participants undergo microscopic cauterization using 50% silver nitrate applied to the perforation margins until blanching occurs, followed by Gel foam placement. This procedure is repeated weekly for up to 4 weeks. Control Group (Group B): Participants are managed conservatively to observe spontaneous healing without chemical intervention over 4 weeks. All participants are evaluated weekly for 4 weeks via otoscopic examination to monitor healing progress. Statistical analysis will compare total healing rates between groups and stratify for confounding variables such as age, gender, etiology, and initial perforation size.

Inclusion criteria

• Patients aged between 18 and 60 years
• Small, unilateral tympanic membrane perforation in the pars tensa (<25% of surface area, present in one quadrant)
• Dry perforation for at least 4 weeks
• Perforation size <4 mm in diameter
• Conductive hearing loss with an air-bone gap of ≥15 dB on Pure Tone Audiometry (PTA)

Exclusion criteria

• Age <18 years or >60 years
• Bilateral tympanic membrane perforations
• Perforation size >4 mm in diameter
• Discharging ear
• Edematous middle ear mucosa
• Presence of cholesteatoma, granulations, or retraction pockets
• Presence of sensorineural or mixed hearing loss on PTA
• Patients with diabetes mellitus
• Known allergy to silver nitrate
• Unwillingness to undergo silver nitrate cautery or adhere to weekly follow-up