Learning Objectives: Various attempts have recently been made to achieve perforated tympanic membrane closure using minimally invasive ambulatory surgical procedures. Since 2000, we have introduced a treatment procedure to promote regeneration of the tympanic membrane and closure of perforations using a synthetic graft material instead of autografts such as temporal fascia. In that procedure, a perforated tympanic membrane is filled with a synthetic graft material (atelocollagen sponge/silicon membrane; TERUDERMIS^®), to which human fibroblast growth factor is applied to promote wound healing (bFGF preparation; Fibrast Spray^®). This study describes the details of this treatment procedure and discusses the outcome of patients who presented to our outpatient clinic and underwent the procedure for tympanic membrane regeneration over a 2-year period between July 2009 and December 2011 and who were followed for at least 1 year with respect to the preoperative factors that affect closure outcome. Complete closure was achieved in 105 (66.5%) patients after 1 year of postoperative follow up. The incidence of residual perforation was significantly higher in patients with the following four factors than in those without: 1) unidentified perforation margin, 2) severe calcification of the tympanic membrane, 3) marginal perforation, and 4) large perforation. Logistic regression analysis adjusted for the effects of each factor identified marginal perforation as significant factors affecting the outcome of tympanic membrane closure. Tympanic membrane regeneration therapy can be applied to all patients. However, in patients whose perforation margin cannot be identified, in those with severe calcification of the tympanic membrane, and in those with marginal or large perforation, the therapy should be performed prudently after obtaining consent following sufficient explanation that tympanic membrane regeneration may not be achieved.

Various attempts have recently been made to achieve perforated tympanic membrane closure using minimally invasive ambulatory surgical procedures. Since 2000, we have introduced a treatment procedure to promote regeneration of the tympanic membrane and closure of perforations using a synthetic graft material instead of autografts such as temporal fascia. In that procedure, a perforated tympanic membrane is filled with a synthetic graft material (atelocollagen sponge/silicon membrane; TERUDERMIS^®), to which human fibroblast growth factor is applied to promote wound healing (bFGF preparation; Fibrast Spray^®). This study describes the details of this treatment procedure and discusses the outcome of patients who presented to our outpatient clinic and underwent the procedure for tympanic membrane regeneration over a 2-year period between July 2009 and December 2011 and who were followed for at least 1 year with respect to the preoperative factors that affect closure outcome. Complete closure was achieved in 105 (66.5%) patients after 1 year of postoperative follow up. The incidence of residual perforation was significantly higher in patients with the following four factors than in those without: 1) unidentified perforation margin, 2) severe calcification of the tympanic membrane, 3) marginal perforation, and 4) large perforation. Logistic regression analysis adjusted for the effects of each factor identified marginal perforation as significant factors affecting the outcome of tympanic membrane closure.

Tympanic membrane regeneration therapy can be applied to all patients. However, in patients whose perforation margin cannot be identified, in those with severe calcification of the tympanic membrane, and in those with marginal or large perforation, the therapy should be performed prudently after obtaining consent following sufficient explanation that tympanic membrane regeneration may not be achieved.