Acute Traumatic Tympanic Membrane Perforations Research Articles

Observation Versus Gel-Foam Grafting of Acute Traumatic Tympanic Membrane Perforation: Which Is Better?

Observation Versus Gel-Foam Grafting of Acute Traumatic Tympanic Membrane Perforation: Which Is Better?

Use of Platelet Rich Fibrin in Acute Traumatic Tympanic Membrane Perforation Compared With the Conservative Treatment

Use of Platelet Rich Fibrin in Acute Traumatic Tympanic Membrane Perforation Compared With the Conservative Treatment

Human Acellular Dermal Allograft Patch on Traumatic Tympanic Membrane Perforation.

This study aimed to investigate the outcome of using the human acellular dermal allograft patch compared with the conven- tional paper patch in traumatic tympanic membrane perforation. This was a retrospective study including 41 patients (42 ears) treated with 22 human acellular dermal allografts and 20 paper patches for acute traumatic tympanic membrane perforation from April 2013 to June 2020. The procedure was performed by applying human acellular dermal allograft or paper patches after trimming of perforation margins under local anesthesia. Patient's age, sex, cause, duration, side, location, size of perforation, and the result of healing was analyzed. The audiologic or computed tomography data were also investigated when available. There was no significant difference in sex, age, affected side ratio, size and duration of perforation, recovery confirmation time, and audiogram results between the two groups. There was no significant difference in the size or duration of perforation between the success and failure groups. The human acellular dermal allograft and paper-patch groups showed no significant difference in the recovery confirmation time (70.7 ± 42.3 vs. 89.9 ± 119.4 days, P = .486) and recovery rate (95.5% vs. 85.0%, P = .333). However, the patch maintenance time of the human acellular dermal allograft group was statistically longer than the paper-patch group (32.9 ± 14.9 vs. 15.6 ± 19.9 days, P = .001). On multivariable regression analysis, patch material was the only parameter associated with patch maintenance time (P = .002). Treatment outcomes of traumatic tympanic membrane perforation using human acellular dermal allograft showed better or similar therapeutic efficacy compared to paper patch. The important advantage of this material is to stay in situ for a sufficient time without being detached until successful healing.

To patch or not to patch acute isolated traumatic tympanic membrane perforations: a case series and systematic literature review.

To date, there is no consensus about the benefits of paper patching over spontaneous healing in the management of isolated acute traumatic tympanic membrane perforations (IATTMP). In this systematic literature review and case series, we compared paper patching of IATTMP to spontaneous healing in terms of healing rate and time to heal. A systematic literature search of English-language studies published from 1/1975 to 9/2020 was conducted using PubMed via MEDLINE, and 201 studies were identified. Another 346 studies were derived from the references of those articles. Twenty-four studies remained after omitting duplications and articles that did not meet the inclusion criteria. Demographics, medical history, physical examination, and audiometric results in the selected publications and in a new series of patients treated for IATTMP between 1/2018 and 1/2021 in a single tertiary referral center were retrieved and analyzed. The literature review yielded 2796 ears of which 466 underwent paper patching (intervention arm). Complete perforation healing was documented in 67-97% of control arm and 92-93% of intervention arm. Our new series included 29 ears of which six underwent paper patching. Complete healing was observed in 83% and 78% in the interventional and control arms, respectively. Although paper patching and watchful waiting had similar success rates in patients with IATTMP, healing after paper patching was slightly quicker among our patients. Patching is a readily applicable and technically simple office-based intervention that should be preferentially considered for IATTMP.

Use of Platelet Rich Fibrin in Acute Traumatic Tympanic Membrane Perforation Compared With the Conservative Treatment

Objectives: To evaluate the effect of platelet rich fibrin in treating acute traumatic tympanic membrane perforation as regards wound healing and hearing outcome compared with conservative treatment. Methods: This study was conducted on 50 patients presented with acute traumatic tympanic membrane perforation classified randomly into 2 groups: the study group; (25 patients) treated with platelet rich fibrin membrane and control group; (25 patients) underwent conservative treatment. Patients were followed up for 6 weeks to assess healing rate of the tympanic membrane perforation and hearing improvement. Results: In the group where platelet rich fibrin was used, complete perforation closure occurred in 88% of patients, while in the group treated conservatively, closure was obtained in 56% (P 0.004). The mean air bone gap improved in the platelet rich fibrin-treated group from 18.83±3.99 dB to 3.38±4.13 dB and in the control group from 18.90±3.43 dB to 9.84±8.04 dB. The post-treatment mean air bone gap significantly improved better in the platelet rich fibrin-treated group than in the control group (P 0.004). Hearing gain by >10 dB was obtained in 88% of patients in the platelet rich fibrin group and in 44% of patients in the control group (P 0.001). Conclusion: In comparison with the conservative management, platelet rich fibrin, as an autologus simple graft method, provided more healing rates with better audiological outcomes with low cost and no complications.

Novel transparent collagen film patch derived from duck’s feet for tympanic membrane perforation

To increase healing rate of tympanic membrane (TM) perforations, patching procedure has been commonly conducted. Biocompatible, biodegradable patching materials which is not limited across cultures is needed. The authors evaluated the effectiveness of novel transparent duck’s feet collagen film (DCF) patch in acute traumatic TM perforation. This procedure was compared with spontaneous healing and paper patching. Cell proliferation features were observed in paper and DCF patches. Forty-eight TMs of 24 rats were used for animal experiment, perforations were made on each TMs, and divided into three groups according to treatment modality. Sixteen were spontaneously healed, 16 were paper patched and 16 were DCF patched. The gross and histological healing results were analyzed. Both paper and DCF patch showed no cytotoxicity, but cell proliferations were more active in DCF than paper in early stage. In animal study, the healing of TM perforations were completed within 14 days in all three groups, but found to be faster in DCF patch group than paper patch or spontaneous healing group. The DCF patches were transparent and size of DCF patches were gradually decreased, so there were no need to remove the DCF patches to check the wound status or after the completion of healing. According to this result, authors concluded that DCF patch is transparent, biocompatible and biodegradable material, and can induce fast healing in acute traumatic TM perforations.

Acceleration of Healing of Traumatic Tympanic Membrane Perforation in Rats by Implanted Collagen Membrane Integrated with Collagen-Binding Basic Fibroblast Growth Factor.

Traumatic tympanic membrane (TM) perforation is very common in clinical practice. Several biomaterials have been reported to play a role in TM reparation, whereas their functional recovery is limited when used alone. Meanwhile, the administration of biofactors could promote functional recovery, but rapid distribution and short half-time obstruct their application. To study the effect of traumatic TM regeneration, we prepared collagen membrane (CM) integrated with collagen-binding basic fibroblast growth factor (CBD-bFGF) and implanted into the injury site of perforated TM in Sprague-Dawley rats. The study on CBD-bFGF in vitro showed that CBD-bFGF accelerated the proliferation of human fibroblast cell HS-865 biologically and was released from CM gradually. In vivo study, through the gross anatomy, auditory brainstem responses assay, histological staining, and transmission electron microscopy observation at d7, d14, and d28 after the acute TM perforation, we found that CBD-bFGF-integrated CM promoted the healing rate at an early stage (∼7 days), reduced the healing time of perforated TM, and notably retrieved the structure and hearing of TM. These findings suggest that CM modified with CBD-bFGF could be therapeutically appropriate for the treatment of TM perforation.

A prospective study evaluating spontaneous healing of aetiology, size and type‐different groups of traumatic tympanic membrane perforation

To evaluate the outcome of spontaneous healing of aetiology-, size- and type-different groups of acute traumatic eardrum perforation and to characterise changes in the morphology of the healing eardrum in various conditions. Prospective clinical study. University-affiliated teaching hospital. A total of 126 patients who visited the Outpatient Department of the Otolaryngology Clinic of Yiwu Central Hospital, Yiwu, China between January 2008 and June 2009 with acute traumatic tympanic membrane perforations. All participants were allowed to heal spontaneously for 12 months. The clinical outcome including healing rate, healing time, hearing function and air-bone gap recovery as well as morphological changes of the healing tympanic membrane was evaluated on the bases of perforation aetiology, size and type, etc. By perforation size, the overall healing rate at the end of the 12-month follow-up was comparable to each other in the three (small, medium and large) size groups (P > 0.05); however, there were significant perforation size-dependent differences in the average closure time (P < 0.05). For serosanguinous discharge and dry perforations, the healing rate at the end of 12-month follow-up was similar (95%versus 85%, P > 0.05), but the average healing time was different (16 versus 28 days, P < 0.01) and so was the sequence of granulation tissue formation and epithelial migration in the course of perforation healing. The inverted or everted edges as compared with no curled edges did not significantly affect the healing rate (95%versus 82%, P > 0.05) or closure time (24 versus 27 days). Hearing loss differed significantly between perforations of different causes (P < 0.01), but the perforation cause did not affect recovery of the air-bone defect. Pre-existing tympanosclerosis was the most prominent cause of healing failure. The clinical outcome of spontaneous healing of acute tympanic membrane perforations is generally associated with perforation size, aetiology and whether dry or with a serosanguenous discharge. The sequence of granulation tissue formation and epithelial migration differs during the healing of traumatic tympanic membrane formation in serosanguinous discharge conditions and dry perforation.

Topical application of transforming growth factor‐β1 in acute traumatic tympanic membrane perforations: an experimental study in rats

High transforming growth factor-beta1 (TGF-beta1) expression in combination with fibrotic scar was observed in human tympanic membranes containing a chronic perforation. The purpose of this study was to investigate whether application of exogenous TGF-beta1 to experimentally created tympanic membrane perforations might induce a nonhealing tympanic membrane perforation. Bilateral myringotomies were performed in 20 rats. In 10 animals, a single dose of TGF-beta1 (0.1 microg) was topically applied to the left tympanic membrane after perforation. In the second part of the study with 10 animals, repeated applications of TGF-beta1 at a higher concentration were tested. In both groups, the opposite ears received vehicle alone. Tympanic membranes were observed for a total of 5 weeks. The effect of TGF-beta1 on the healing of the tympanic membranes was evaluated by closure rates and histology. In the single application group, the healing process was not delayed. Repeated applications of TGF-beta1 did cause a faster perforation closure and a thicker tympanic membrane. Topical TGF-beta1 applied to a traumatic tympanic membrane perforation does not create a chronic perforation at the concentrations and modes of application used in this study.

Acute Traumatic Tympanic Membrane Perforation-Reply

In Reply.—The aim of our investigation concerning patients with acute traumatic tympanic membrane perforations was to compare the healing rate between those treated by paper patching of the tympanic membrane and those not patched. We could find no difference in the healing between these two groups. Among our patients allocated to the control group, and thus not supposed to be covered, two of 20 patients were taken out of the study. They complained of dysacusia that disappeared after covering of the tympanic membranes. I fully agree with Dr Wallenborn that patching is indicated if the patient complains of decreased hearing and tinnitus, although I do not share the conclusion that most patients need treatment due to these symptoms. All patients, however, should be carefully evaluated by an ear, nose, and throat specialist.