Traumatic Tympanic Membrane Perforation in Children in the Emergency Department: Comparison of Spontaneous Closure and Paper Patch.

Serkan Cayir,Huseyin Mutlu

doi:10.7759/cureus.7697

Abstract

ObjectiveThere are different clinical approaches for traumatic tympanic membrane perforation in the pediatric age group. The purpose of this study was to compare spontaneous recovery and the paper patch procedure and to analyze the factors that play a role in recovery.Materials and methodsPediatric patients who were admitted to the Emergency Department between January 2014 and June 2019 due to traumatic tympanic membrane perforation were investigated. Among these patients, medical records of cases followed by the otorhinolaryngology clinic for spontaneous closure or paper patch procedure were retrospectively examined. Medical records of a total number of 71 patients aged 2-16 years (33 females, 38 males) were analyzed.ResultsThe overall closure rate was 89.75% (64/71). Although there was no difference between the groups of small- and medium-size perforations in terms of closure rates, the closure rate in large perforations was 90.9% in the paper patch group and 63.6% in the spontaneous closure group, and the difference between these two groups was statistically significant (p < 0.05). Additionally, the closure rate in the paper patch group (91.6%) was found to be significantly higher than that in the spontaneous closure group (58.3%) in the presence of a perforation contacting the malleus (p > 0.05).ConclusionBoth procedures can be employed in pediatric cases of traumatic tympanic membrane perforation with high success rates. However, in case of a large perforation or a perforation contacting the malleus that is detected in the Emergency Department, it is necessary to refer the patients to the otorhinolaryngology clinic immediately for paper patch procedure instead of following up the patients for spontaneous closure.

Highlights

Tympanic membrane perforations (TMPs) in children occur owing to various reasons, and the most common reasons include blunt trauma to the ear, barotrauma, and foreign objects
There was no difference between the groups of smalland medium-size perforations in terms of closure rates, the closure rate in large perforations was 90.9% in the paper patch group and 63.6% in the spontaneous closure group, and the difference between these two groups was statistically significant (p < 0.05)
These perforations that occur are generally prone to spontaneous closure; the perforation size and possibility of spontaneous recovery are negatively correlated, and large perforations need longer recovery time [1]

Summary

Introduction

Tympanic membrane perforations (TMPs) in children occur owing to various reasons, and the most common reasons include blunt trauma to the ear, barotrauma, and foreign objects. The tympanic membrane is highly sensitive to sudden changes in pressure in the external auditory canal and may get affected by these changes and get damaged. These perforations that occur are generally prone to spontaneous closure; the perforation size and possibility of spontaneous recovery are negatively correlated, and large perforations need longer recovery time [1]. Epithelial regeneration areas are present in the proximities of the annulus and the manubrium of the malleus, and perforations heal through epithelial migration from both directions [2]. Epithelial migration that occurs toward the perforation center on a flat plane is described as centripetal migration, whereas migration that occurs upward and toward the distal end of perforation is described as outward migration [3]

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Discussion

Conclusion