Topical insulin for treatment of small central perforations - a pilot study

Options for treatment of small central perforations (CP) of tympanic membrane (TM) such as chemical cautery of the margins arefrequently preferred totympanoplasty. The size of the perforation increases initially due to cautery or may remain the same. Insulin may be therapeutic agent in treating such small CP of the TM by its growth enhancing effects. We used topical diluted Human R insulin in seven patients. A total of ten perforations were treated in this trial. This included a unilateral CP of the TM in five cases, bilateral CP of TM in one case, single graft perforation (GP) post myringoplasty and recurrent double graft perforation following coryza in the same patient. A gelfoam soaked with dilute Human R Insulin was placed at the site of the perforation in the ENT outpatient. The procedure was repeated on daily basis or alternate days based on patient's convenience. Successful epithelialization of the CP was noted in as less as two instillations. A maximum of ten instillations were done before healing was noticed without local or systemic side effects. Out of ten perforations, five healed (including three GP), three did not heal, one started discharging and one cannot be commented as patient was lost for follow up. This is the first clinical study showing application of insulin for treatment of small CP of TM or GP in patients and proves to have a beneficial effect in healing in selected patients.