Skip to main content Accessibility help

Hyaluronic acid ester in myringoplasty

  • M Prior (a1), N Gibbins (a2), G John (a3), S Rhys-Williams (a3) and P Scott (a3)...



To investigate the use of a new technique to close persistent tympanic membrane perforations under general anaesthesia, in patients in whom this has previously been considered impractical.


Twenty patients aged 50 years and over were recruited. All had a persistent, symptomatic tympanic membrane perforation in at least one ear. Pre-operatively, an audiogram was performed and the tympanic membrane was assessed in order to establish the site and size of the perforation. Under general anaesthesia, the edges of the perforation were freshened and a sheet of Epifilm, trimmed to a size roughly 2 mm larger in diameter than the perforation, was tucked through the perforation. The ear was dressed appropriately. Patients were seen two weeks post-operatively in the out-patients department and reassessed.


The study was based at Poole General Hospital, a District General Hospital.


Twenty patients were recruited from the out-patients clinics of Poole Hospital ENT department.

Main outcome measures:

(1) closure of the perforation, as a percentage of the original size; (2) improvement of hearing, as an average across all frequencies, expressed in dB hearing level; and (3) presence or absence of discharge.


Five patients were operated upon and assessed six weeks post-operatively. The Epifilm had dissolved but the perforations remained the same size in all five patients. There were no other adverse effects. Pure tone audiometry at this stage was redundant. The study was subsequently aborted.


The authors conclude that repair of tympanic membrane perforations with hyaluronic acid ester films is not to be recommended.


Corresponding author

Address for correspondence: Mr Matthew Prior, Consultant Otolaryngologist, ENT Department, Derriford Hospital, Plymouth PL6 8DH, UK. Fax: 01752 763299 E-mail:


Hide All
1 Booth, J, ed. Scott-Brown's Otolaryngology, 6th edn. Oxford: Butterworth-Heinemann, 1997:4
2 Austin, DF, Shea, JJ. A new system of tympanoplasty using vein graft. Laryngoscope 1961;71:596611
3 Williamson, PA, Thomas, DM, Beasley, P. Posterior tragal perichondrium harvesting for myringoplasty. Clin Otolaryngol 1999;24:252–4
4 Cross, CW, Bassila, M, Lazar, RH, Long, TE, Stagner, S. Adipose tissue plug myringoplasty techniques in children. Otolaryngol Head Neck Surg 1999;101:617–20
5 Inamoglu, M, Isik, AU, Acuner, O, Harova, G, Bahadir, O. Fat-plug and paper-patch myringoplasty in rats. J Otolaryngol 1999;27:318–21
6 Maeta, M, Saito, R, Nakagawa, F, Miyahara, T, Uno, K, Sonobe, N. A clinical comparison of orthodox myringoplasty and a simple method with fibrin glue. Journal of the Oto-Rhino-Laryngological Society of Japan 1998;101:1062–8
7 Sakai, N, Kokobun, T, Asai, T, Kurihara, H, Nishizawa, N, Matsushima, J et al. Simple in-office closure of small intractable tympanic membrane perforations after myringoplasty. Aurus Nasus Larynx 1997;24:43–6
8 Puls, T. Myringoplasty: is molded collagen xenograft a valid alternative for fresh temporalis fascia? Acta Otorhinolaryngol Belg 1996;50:111–14
9 Sheehy, JL, Anderson, RG. Myringoplasty: a review of 472 cases. Ann Otol Rhinol Laryngol 1980;89:331–4
10 Somers, TH, Houben, V, Goovaerts, G, Govaerts, PJ, Offeciers, FE. Histology of the perforated tympanic membrane and its muco-epithelial junction. Clin Otolaryngol 1997;22:162–6
11 Rizer, FM. Overlay versus underlay tympanoplasty. Part II: the study. Laryngoscope 1997;107:2636
12 Doyle, JP, Schleuning, AJ, Echevarria, J. Tympanoplasty: should grafts be placed medial or lateral to the tympanic membrane? Laryngoscope 1992;82:1425–30
13 Kotecha, B, Fowler, S, Topham, J. Myringoplasty: a prospective audit study. Clin Otolaryngol 1999;24:126–9
14 Xomed Surgical Products Inc. Epifilm Product Information. Watford, UK: Xomed Surgical Productions, 2001
15 Chauvin, K, Bratton, C, Parkins, C. Healing large tympanic membrane perforations using hyaluronic acid, basic fibroblast growth factor, and epidermal growth factor. Otolaryngol Head Neck Surg 1999;121:43–7



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed