How to close a tympanic membrane perforation using Epidermal Growth Factor (EGF)?

Tympanic Membrane Perforation Closure Using Epidermal Growth Factor (EGF)

The most effective technique for closing tympanic membrane perforations using Epidermal Growth Factor (EGF) involves application of EGF with a suitable scaffold material after freshening the perforation edges, which has demonstrated closure rates of up to 98.1% in clinical trials. 1

Preparation and Assessment

• Thoroughly clean the ear canal and remove any debris to create optimal conditions for healing 1
• Assess the size and location of the perforation to determine the appropriate amount of EGF needed 2
• Ensure the ear is free from active infection before beginning treatment, as infections can impair healing 3

EGF Application Procedure

• Freshen the edges of the perforation to stimulate the healing process by removing epithelialized tissue at the margins 1
• Apply EGF using a suitable scaffold material:
  • Gelatin sponge or Gelfoam is commonly used as an effective scaffold 2, 4
  • Hyaluronic acid can also serve as an effective carrier for EGF 2
• Dosing recommendations:
  • Apply approximately 1.0 μg of EGF directly to the tympanic membrane perforation 2
  • For larger perforations, multiple applications may be necessary 2, 5

Treatment Protocol

• Short-term application protocol (recommended):
  • Apply EGF weekly for 2-3 weeks 2
  • Complete closure can be expected in approximately 21 days with this regimen 2
• Long-term application caution:
  • Avoid prolonged EGF application beyond 3 weeks as it may lead to progressive thinning of the healed membrane and potential reperforation 5
  • Extended use has been associated with cholesteatoma formation in animal studies 5

Monitoring and Follow-up

• Evaluate healing progress weekly during treatment 2
• Complete closure should be expected within 3-4 weeks in most cases 2, 4
• If symptoms don't resolve after 2 weeks of treatment, reevaluation is necessary 3
• Assess hearing function after closure to confirm functional improvement 6

Combination with Other Growth Factors

• Consider combination with basic Fibroblast Growth Factor (b-FGF) for enhanced results:
  • b-FGF has demonstrated 98.1% closure rates in clinical trials 1
  • b-FGF particularly stimulates the middle fibrous layer of the tympanic membrane, potentially resulting in a stronger repair 4
• Hyaluronic acid can be used in combination with EGF for improved healing outcomes 2

Precautions and Contraindications

• Use only non-ototoxic preparations when the tympanic membrane is not intact 1, 3
• Keep the ear dry during the healing process to prevent infection 3
• Avoid ear irrigation and pneumatic otoscopy during the healing period 3
• Monitor for external canal hypertrophy, which has been reported with some growth factor applications 2

Expected Outcomes

• Complete closure can be expected in up to 100% of cases with proper EGF application 2
• Hearing improvement typically follows successful closure 1, 6
• The healed membrane may initially appear hypertrophic but will thin to normal proportions over time 4

Common Pitfalls to Avoid

• Avoid long-term application (>3 weeks) of EGF as it may lead to reperforation and cholesteatoma formation 5
• Don't apply EGF in cases with active infection; treat the infection first 3
• Ensure proper placement of the scaffold material to maintain contact between EGF and the perforation edges 2, 4
• Don't use excessive amounts of EGF as this may cause unwanted tissue hypertrophy 2