Diseases of The Middle Ear
Treatment of choice in central safe perforation is:
There are 2 schools of thought as faras this question is concerned - Some believe that.
a. TOC of central perforation is myringoplasty.
b. TOC of tubo tympanic CSOM is conservative management.
But according to Turner 70/e, p 285 - central perforation/ tubo tympanic CSOM are both managed conservatively by antibiotics and by keeping the ear dry.
"If there is recurring discharge or if there is deafness sufficient to cause disability, closure of the perforation by myringoplasty should be considered."
According to Scott's Brown
a. Dry perforations that are symptom free do not require usually require closure.
b. If the only symptom is a hearing impairment, the chances of improving hearing with surgery should be considered carefully, not just the hearing in the operated ear but the overall hearing ability of the patient.
c. In patients with a H/O intermittent activity, surgery to close the perforation is probably indicated to minimize future activity.
d. So from all above discussions it is clear that TOC for central safe perforation is conservative management.