EGF and chronic purulent otitis media: The presence of CSOM in chronic TMPs attenuates tympanic membrane healing, where recurrent inflammation of the middle ear and bacteriotoxins inhibits endogenous healing mechanisms, such that scar hyperplasia of dense fibrous connective tissue manifests at the perforation edge.24, 28 We believe that excision of thickened tawny tissue and topical application of EGF merely assisted and guided the normal tympanic membrane healing process.