erein, we present a review of the manuscript titled ‘Treatment of tympanic membrane perforation using bacerial cellulose: A randomized controlled trial’’ by Silveira t al.1 The work outlined in this manuscript was interesting. fter review, we agree with the authors that bacterial celulose is an excellent material for tympanic membrane (TM) egeneration and may be an effective alternative to conentional myringoplasty. However, we believe the following etails of this study should be further clarified: The size of the perforation: Although the authors eported a 100% closure rate using bacterial cellulose in 4 small chronic TM perforations, they calculated this rate y categorizing the size of the perforation as small or edium. However, they did not clearly describe the perfoation diameter as a measurement (i.e., in millimeters or as percentage of the TM). Previously published studies indiate that the use of Gelfoam or paper patch tympanoplasty n small chronic TM perforations is effective. Anders Niklason et al.2 reported that Gelfoam plug myringoplasty was uccessful for 12 small chronic TM perforations, 2--4 mm in ize. Another study by Park et al.3 reported a closure rate of 8.3% using cigarette paper on 23 chronic TM perforations, ess than 5% of the TM in size. Similarly, Golz et al.4 reported 78.3% closure rate using cigarette paper in 38 chronic TM erforations, less than 3 mm in size. It is also important to ote that Gelfoam and cigarette paper are convenient, easy o use, and inexpensive compared to bacterial cellulose.