The effect of topical estrogen on healing of chronic tympanic membrane perforations and hearing threshold

Considering the presence of squamous epithelial cells and fibroblasts in the tympanic membrane (TM), topical estrogen application may influence the repair of TM perforations. Therefore, this study was designed to investigate the healing effect of topical estrogen on chronic TM perforations and improvement in hearing threshold. Sixty patients were enrolled in a randomized clinical trial. Thirty patients were treated with paper patch and 30 with estrogen-impinged paper patch. Complete closure of the TM perforation and hearing threshold were evaluated in both groups. Chronic unilateral perforations of the TM involving less than 40% of the total area of the TM without active disease in the middle ear were selected. The margin of the perforation was chemically trimmed using 15% trichloroacetic acid and patching performed under an operating microscope. Microscopic examination was performed after 14 days and repeated after 30 days. Complete closure of the TM perforation was considered as successful repair. Hearing threshold was determined before the start of the trial and 30 days after treatment. No significant difference was found between the two groups after 14 days in complete closure of the perforation (P = 0.310). After 30 days, patients treated with estrogen-impinged paper patch showed a significantly higher rate of closure of the perforation (63.4%) and improvement in hearing threshold (P = 0.017). Topical estrogen may have a healing effect on chronic TM perforations and improvement in hearing threshold.