Marginal Tympanic Membrane Perforations: A Critical View

Abstract

Objectives: (1) Assess the marginal perforation prevalence in patients with chronic otitis media (COM). (2) Analyze evidence suggesting prior moderate or severe tympanic retractions (TM) of the pars tensa in marginal perforation cases. (3) Correlate the abnormal findings with those in the contralateral ear (CLE). Methods: Prevalence study. The bilateral videotoscopies of 1510 patients diagnosed with COM in a tertiary hospital were analyzed. Previous TM retraction was evaluated according to: (1) medialization of the manubrium of malleus, (2) remnant tympanum adhered to the ossicular chain, (3) remnant tympanum adhered to the promontory, and (4) ossicular chain erosion. The videotoscopies of the CLE were also described. Results: Of the 1510 patients evaluated, 34 (2.25%) had marginal TM perforation. Only 5.9% of ears showed no evidence of previous retraction, and 88.3% showed 2 or more abnormal findings. The CLE was diagnosed with perforation-retraction (2.9%), moderate or severe retraction (52.9%), and cholesteatoma (14.7%); 23.5% were normal. Conclusions: The study population had a low marginal perforation prevalence. The vast majority of ears with marginal perforation had evidence suggesting previous TM retraction. In addition, retraction or cholesteatoma occurred in 70.5% of CLE.