We would like to address the article titled “Use of ambulatory anesthesia with manually assisted ventilation for tympanic membrane regeneration therapy in children” by Hakuba et al. .

The work is very interesting. The methods are simple and convenient, and may, for children cases, replace conventional myringoplasty. However, in some children surgery using ambulatory anesthesia with manually assisted ventilation was usually used in some hospital when surgical time was very short, for example, excision of congenital preauricular fistula, extracting esophageal foreign body, etc. It is more important whether adding a single dose of 0.1–0.2 mL of bFGF solution can produce biological effect and accelerate the closure of perforation in the author’s study. The in vitro half-life of bFGF is approximately 12 h . Continuous or cyclical topical application of bFGF (e.g. a bFGF dose of once a day or once every other day) is used to repair human and experimental acute and chronic TMPs . In addition, previous and recent some studies have denoted that excision of the perforated edge plus patching alone (e.g. Gelfoam®, atelocollagen sponge, bacterial cellulose, and paper patch) was effective for the treatment of chronic TMPs and had higher success rate . Thus, adding a single dose of bFGF solution was not necessary for myringoplasty. The author should perform a randomized control study to compare the efficacy of atelocollagen membrane with or without bFGF on chronic tympanic membrane perforation in children. Otherwise, adding bFGF solution only can increase the medical cost and prolong the surgical time.