Traumatic Traumatic Tympanic Membrane Perforations Research Articles

The Effect of Using Ofloxacin Ear Drops in Traumatic Tympanic Membrane Healing: A Systematic Review and Meta-Analysis.

Objectives: To evaluate the effectiveness of ofloxacin ear drops versus no intervention in the repair of traumatic tympanic membrane (TM) perforations from randomized controlled trials (RCTs). Data Sources: Medline/PubMed, CENTRAL, Clinical Trials.Gov, and Google Scholar. Study Selection: Inclusion criteria: (1) English language; (2) RCT studies; (3) reported the outcomes on the application of ofloxacin and outcomes of spontaneous healing. Exclusion criteria: (1) studies without a control group; (2) patient with severe otologic disease such as chronic suppurative otitis media or ossicular disruption or patients with craniocerebral injury; (3) studies with no pretreatment values or single-arm clinical studies. Data Extraction: Country, year of publication, number of participants in each arm, patient characteristics such as age, sex, intervention details, laterality, cause of TM perforation, position of perforation, follow-up time, hearing gain, rate of TM closure, and closure time. Results: A total of 6 RCTs studies were analyzed. A total of 502 participants were included; the relative risk for closure rate of ofloxacin treatment was 1.18 [95% confidence interval (CI), 1.08 to 1.28, P < .001] and the mean difference (MD) for healing time was -18.4 (95% CI, -19.96 to -16.82, P < .001), suggesting ofloxacin has a significant effect on closure of TM perforations. However, no clinically significant effect in hearing (SMD: 0.21, 95% CI, 0.02 to 0.40, P = .03) was seen in ofloxacin group. Also, patients in the ofloxacin group were associated with a 13% reduction in the risk of infections compared to their observation-assigned counterparts, but this estimate was not statistically significant. Conclusion: Ofloxacin use in patients with traumatic TM perforation is effective in reducing healing time and increasing rate of TM perforation closure. No evidence of increased risk of hearing loss or infection rates are encountered when ofloxacin is prescribed to patients with traumatic TM perforation.

Traumatic Perforation of Tympanic Membrane in A Tertiary Hospital in South-Eastern, Nigeria

Introduction: Traumatic tympanic membrane (TM) perforation is a commonly encountered otological condition with consequent hearing impairment and potentials for more grievous complications. We aim to establish the prevalence, sex distribution, laterality and aetiological factors associated with traumatic TM perforation in our locality Materials and Method: This is a 10 Year retrospective study involving patients who were managed for traumatic TM perforations at ENT outpatient clinic of Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State. Results: A total of 186 patients were managed for traumatic TM perforation involving 190 ears. The prevalence was 4.9%; 66.1% were males, 33.9% females giving a male to female ratio of 2:1 while age ranges from 1-68 years (mean± SD was 22.23± 15years. Left ear was involved in 54.3% of the cases, right ear in 43.5% and both ears in 2.2%. The commonest cause of traumatic TM perforation was Assaults (58.1%) of various kinds; domestic violence was the commonest, accounting for 22% of all the assault cases followed by assaults from security men (15.1%), then, slap by school teachers, prefects and senior students (10.2%). Mob actions and attacks by Robbers constituted 10.2%. Fifteen percent (15%) of the cases resulted from ear cleaning with cotton bud (10.2%), broom stick (3.2%) and metallic objects (2.2%). Sports related injuries accounted for 2.7% of the cases. Various forms of accidents (8.1%) such as road traffic accidents (1.1%), accidents from work place (3.2%) and fireworks (1.6%) were recorded. Conclusion: The predominance of slap as the major cause of TM perforation resulting from assaults shows how this condition is caused by avoidable circumstances. Every opportunity should be explored to educate the populace on the sequelae of such indiscriminate outburst of anger.

Acellular Collagen Scaffold With Basic Fibroblast Growth Factor for Repair of Traumatic Tympanic Membrane Perforation in a Rat Model.

To evaluate the efficacy of acellular collagen scaffold (ACS) in combination with basic fibroblast growth factor (bFGF) for the repair of traumatic tympanic membrane (TM) perforation in a rat model. A prospective controlled animal study in a rat model of traumatic TM perforation. Tertiary medical center. Sprague-Dawley rats (N = 84) with unilateral traumatic perforation of the right TMs were randomized to receive ACS, bFGF, ACS in combination with bFGF (ACS/bFGF), or nothing (spontaneous healing without any interventions as a control group). The healing outcomes were evaluated by otoscopy, optical coherence tomography, histology, and transmission electron microscopy at 1, 2, and 4 weeks postoperatively. The hearing outcomes were assessed with auditory brainstem response testing. ACS/bFGF resulted in higher perforation closure rates at an earlier stage than spontaneous healing, ACS, and bFGF. Based on histology, optical coherence tomography, and transmission electron microscopy, a trilaminar structure and uniform thickness with mature, densely packed collagen fibers were seen in the ACS/bFGF group. Auditory brainstem response evaluation also showed that ACS/bFGF treatment promoted faster functional hearing recovery as compared with the control group. ACS is an effective TM scaffold and a carrier for bFGF. ACS/bFGF improves the TM closure rate, results in better-reconstructed TMs, and improves hearing. ACS/bFGF serves as a potential substitute for TM perforations in clinical settings.

Dose- and starting time-dependent effect of the application of EGF to the regeneration of traumatic eardrum

Background: Some studies have shown that topical application of epidermal growth factor (EGF) accelerates healing in traumatic tympanic membrane perforations (TMPs), however, the optimal dose and starting time of application have not been established.Objectives: To determine the optimal dose and starting time of application of EGF for the regeneration of TMPs.Methods and materials: Patients with traumatic TMPs were first randomly assigned to low-dose EGF, high-dose EGF, and spontaneous healing groups. Then, the same patients were retrospectively analyzed at 6 months based on the starting time of treatment. The closure times, closure rates, and hearing gain were compared among the groups at 6 months.Results: The mean closure time was 10.20 ± 5.13 days in the low-dosage EGF group, 14.39 ± 6.20 days in the high-dosage EGF group, and 33.17 ± 16.37 days in the spontaneous healing group; the difference was significant (p < .001).Conclusions: Daily application of EGF shortened the closure time of traumatic TMPs compared with those that healed spontaneously. However, high-dose EGF instead prolonged the closure time compared to low-dose EGF.

Histological Study of The Healing of Traumatic Tympanic Membrane Perforation After Vivosorb and Epifilm Application.

Untreated traumatic tympanic membrane perforations (TMPs) may lead to permanent perforations and hearing loss. There are many materials that have been previously used for repairing the TMPs. The purpose of this study is to evaluate the clinical and histological effects of Vivosorb (Vv) and Epifilm on healing of TMPs in a rat model. The posterior-inferior quadrant of the tympanic membranes (TMs) in right ears of 14 rats was perforated using a 20-g needle and then the animals were randomly divided into 2 equal groups (n = 7). The perforated right TMs were treated with either Vv (Vv group) or Epifilm (Ep group). The left TMs of 7 rats were perforated in same way and allowed to close spontaneously without any topical material applications (spontaneous closure group as sham control, SC). The left tympanic membranes of the other 7 rats were not perforated and used as normal controls (NC group). On postoperative 15th day, tympanic bullas were extracted from killed rats and examined morphometrically and histopathologically. Perforation closure rate was 85.7% (6/7) in both Vv and SC groups. Perforations of Ep group closed in 7/7 (100%) ears. The thicknesses of the perforated membranes were increased in SC and especially Vv groups. Also, connective tissue fibrosis, blood clots, and epithelial degenerations were detected in SC and Vv groups. The mean fibroblastic reaction scores of Vv, Ep, and SC groups were 2.14(+), 0.57(+), and 1.71(+) respectively, on comparison with NC group. The mean neovascularization score was 1.42(+) in Vv group, 0.14(+) in Ep group, and 0.57(+) in SC group. Vivosorb and especially Epifilm can improve the healing process in traumatic TMPs and additionally, Epifilm might be more preferred for the treatment of TMPs because of causing lesser fibrosis.

Pretreatment factors affecting traumatic tympanic membrane regeneration therapy using epidermal growth factor

ObjectiveThe use of epidermal growth factor (EGF) to achieve closure of human traumatic tympanic membrane perforations (TMPs) was recently reported. However, pretreatment factors affecting healing outcomes have seldom been discussed. This study was performed to evaluate pretreatment factors contributing to the success or failure of TMP healing using EGF. Design and participantsThis was a retrospective cohort study of 95 TMPs who were observed for at least 6 months after EGF treatment. Eleven factors considered likely to affect healing outcome were evaluated by univariate and multivariate logistic regression analyses. InterventionsEach traumatic TMP was treated by daily topical application of EGF. The main outcome measures were complete closure versus failure to close and mean closure time. ResultsA total of 95 patients were included in the analyses. The total closure rate was 92.6% at 6 months, and the mean closure time was 10.5 ± 4.8 days. The closure rate was not significantly different according to the duration of perforation ≤3 days and >3 days (P = 0.816). However, the mean closure time was significantly different according to the duration of perforation (P < 0.001). The perforation size did not affect the closure rate (P = 0.442). The mean closure time in the low-dose EGF group was significantly shorter than that in the high-dose EGF group (P = 0.001). Logistic regression analyses showed that perforations with preexisting myringosclerosis were more likely to fail to close compared to those without preexisting myringosclerosis (P = 0.001). Multivariate logistic regression analyses showed that the duration of perforation (P = 0.011), size of perforation (P < 0.001), and involvement of the malleus in perforation (P = 0.005) were factors independently correlated with closure time. ConclusionsDaily application of EGF can be used to treat all traumatic TMPs. The size of the perforation and inverted edges did not affect the closure rate, and the most beneficial dosage was sufficient to keep the eardrum moist. Multivariate logistic regression analyses revealed a significant correlation between preexisting myringosclerosis and failure to heal. Nevertheless, the size of perforation, starting time of application, and malleus injury were independent prognostic factors for prolonged healing time.

Determinants of holistic outcome in traumatic tympanic membrane perforation

Objective: The goal of this study is to understand the perforation closure dynamics and to elucidate the factors playing vital role in closure of traumatic tympanic membrane perforation (TMP). Study Design: This was a prospective, sequential allocation, three armed, January 2015–June 2017 (30 months). Setting: This study was conducted at university teaching tertiary hospital. Sample Size: A sample size was 309 (291 patients and 294 ears). Results: The total number of patients included was 291 and the total ears were 294 being bilateral traumatic TMPs in three patients. The mean age of the patients was 27.9 years. Hearing loss and bleeding from ear were the most common presentation. In majority, the hearing loss was conductive. Slap being the most common etiology. Posteroinferior quadrant was the most common site of injury. The overall mean closure time of this study was 13.32 days. Three patients were lost to follow-up. Perforation healing rate in this study was 98.98% at 1 month, and there was a significant difference in healing rate for small and large perforations. We have studied all the three variables together, i.e., the impact of time of initiating treatment after injury, grade of perforation, and their closure time to understand the closure dynamics of traumatic TMPs which is unique and is first of its kind in literature. Conclusion: The carbolic acid to the edge and paper patch with soframycin is a noninvasive, patient-friendly and low-cost office procedure for traumatic TMP's and if performed within 72 h of injury gives 99%–100% closure rate.

Management of traumatic tympanic membrane perforation: a comparative study.

This prospective study was conducted to evaluate the efficacy of sea buckthorn oil patches in treating traumatic tympanic membrane (TM) perforations. We enrolled 370 patients with traumatic TM perforations of different sizes. These patients were randomly assigned to control group and treatment group. In the treatment group, a sterile cotton patch with sea buckthorn oil was used to cover the TM perforations. In the control group, patients were treated with a sterile cotton patch. The healing rate and time were compared between the two groups. We found that the overall healing rate was significantly higher in the treatment group than in the control group. For middle and large TM perforations, sea buckthorn oil treatment led to a significant increase in the healing rate. At 2 months after injury, the duration of healing was, generally, shorter in the treatment group than in the control group (P<0.05). In conclusion, sea buckthorn oil patches are effective in treating middle and large TM perforations, which results in increased healing rates and decreased healing time.

The effects of fibroblast growth factor-2 delivered via a Gelfoam patch on the regeneration of myringosclerotic traumatic eardrum perforations lying close to the malleus

ObjectiveWe evaluated the effects of fibroblast growth factor-2 (FGF-2) delivered via a Gelfoam patch on the regeneration of myringosclerotic traumatic tympanic membrane perforations (TMPs) lying close to the malleus. Study designA prospective, randomized, controlled clinical study. SettingA university-affiliated teaching hospital. Subjects and methodsWe prospectively analyzed, in a randomized manner, the outcomes of treatment for traumatic TMPs constituting >25% of the tympanic membrane. The closure rates, closure times, and otorrhea rates were compared among patients treated via FGF-2-containing Gelfoam patches, Gelfoam patches alone, and observation only. ResultsWe analyzed data from 138 patients. The perforation closure rates in the FGF-2 plus Gelfoam patch, Gelfoam patch, and observation alone groups were 97.9, 89.8, and 70.7%, respectively. Both the FGF-2 plus Gelfoam and Gelfoam alone groups exhibited significantly higher closure rates than the observational group (both p<0.05).The mean closure times were 15.7±5.1, 24.8±4.9, and 35.7±9.2days in the FGF-2 plus Gelfoam patch, Gelfoam patch alone, and observation alone groups, respectively. The FGF-2 plus Gelfoam patch group exhibited a significantly shorter closure time than the Gelfoam patch alone and observation alone groups (p<0.05). The incidences of purulent otorrhea were 14.6, 6.1, and 4.9% in the FGF-2 plus Gelfoam patch, Gelfoam patch alone, and observation alone groups, respectively. Surprisingly, 7 of 7 (100.0%) perforations associated with purulent otorrhea completely closed in the FGF-2 plus Gelfoam patch group; however, no such perforation healed in either the Gelfoam alone or observation alone group. ConclusionsFGF-2 plus Gelfoam patching significantly shortened the closure time compared to observation and Gelfoam patching alone, and it significantly improved the closure rate (compared to observation alone) of myringosclerotic perforations lying close the malleus. FGF-2 plus Gelfoam patching is a valuable, minimally invasive alternative treatment that may be readily applied to outpatient settings.

Assessment and spontaneous healing outcomes of traumatic eardrum perforation with bleeding

ObjectiveThis study investigated the influence of the degree of bleeding from the remnant eardrum on the spontaneous healing of human traumatic tympanic membrane perforations (TMPs). Study designA case series with chart review. SettingA tertiary university hospital. Materials and methodsThe clinical records of traumatic TMP patients who met the case selection criteria were retrieved and categorized into two groups based on the documented degree of bleeding from the remnant eardrum: with and without bleeding. The demographic data and spontaneous healing outcomes (i.e., healing rate and duration) of these two TMP types were analyzed using the chi-squared test or t-test. ResultsOne-hundred and eighty-eight cases met the inclusion criteria and were analyzed. Of these, 58.5% had perforations without bleeding and the remaining 41.5% had perforations with bleeding. The overall closure rate at the end of the 3-month follow-up period was 90.9% for perforations without bleeding and 96.2% for perforations with bleeding; the difference was not statistically significant (P>0.05). However, the average closure time differed significantly between the two groups (P<0.05): 29.4±3.7days for perforations without bleeding and 20.6±9.2days for perforations with bleeding. The closure rate was significantly different between the groups (62 vs. 15.6%, P<0.01) within 2weeks for medium-sized perforations. In total, 11 (39.3%) large-sized perforations achieved complete closure in the group with bleeding, while none of the large-sized perforations closed in the group without bleeding within 2weeks. The closure rate of medium-sized perforations was not significantly different (79.2 vs. 92%, P>0.05) between the groups without and with bleeding within 4weeks, while the closure rate of large-sized perforations was significantly different between the groups without and with bleeding (27.2 vs. 75%, P=0.0). ConclusionThis study shows that traumatic TMPs with bleeding significantly shortened the closure time compared to TMPs without bleeding. This finding indicates a significant correlation between the prognosis of traumatic TMPs and the degree of eardrum bleeding: severe bleeding from and a hematoma in the remnant eardrum appear to be good signs.

Traumatic Hearing Loss in the Context of Blast-Related Tympanic Membrane Perforation

Identify associated clinical factors and characterize the various forms of hearing loss in the context of blast-related traumatic tympanic membrane (TM) perforation sustained in the combat setting. A prospective study of 41 patients who sustained a TM perforation secondary to blast injury between 2010 and 2012 while serving in combat. Clinical examinations and audiograms were obtained for all patients by a single-institution Otolaryngology service with comparative data generated from review of pre and post-trauma hearing screens. Follow-up clinical and audiogram data were obtained on all available subjects. 59 TM perforations were documented with audiograms. A conductive hearing loss of 14.8, 22.4, 20.3, and 18.9 dB and sensorineural hearing loss (SNHL) of 18.0, 13.5, 19.9, and 22.0 dB at 500, 1,000, 3,000, and 4,000 Hz, respectively, were observed. 49% of all hearing loss was SNHL. Clinical factors did not correlate statically to hearing loss (p > 0.05). On average, patients demonstrated a 51% improvement in SNHL at time of follow-up. In the subacute setting, patients with traumatic TM perforations secondary to combat blast injury demonstrate both a conductive hearing loss and SNHL, with 49% of all loss being sensorineural. An average SNHL improvement of 51% was seen at follow-up.

Fibrinogen-Based Collagen Fleece Graft Myringoplasty for Traumatic Tympanic Membrane Perforation.

Background and ObjectivesThe aim of this study was to investigate how fibrinogen-based collagen fleece (Tachocomb®) graft myringoplasty (FCGM), performed under microscopic guidance, improves both hearing and tympanic membrane tissue repair in patients with traumatic tympanic membrane perforation (TMP).Subjects and MethodsBetween August 2009 and March 2015, a total of 52 patients with traumatic TMP visited the department of otorhinolaryngology at a secondary medical center. Twenty-nine of these underwent FCGM under microscopic guidance in our outpatient clinic. For each patient, we recorded the location and size of the perforation, the time elapsed from the onset of TMP until the myringoplasty, and the hearing level both before and after myringoplasty.ResultsThe TMP closed completely in all cases (29 of 29 patients). After myringoplasty, the postoperative air-bone gap (ABG) differed significantly from the preoperative ABG. Three of the 29 patients (10.3%) experienced complications. Specifically, 2 presented with otorrhea after FCGM, but conservative management led to improvement without recurrence of perforation. One patient showed delayed facial palsy 1 week after the procedure. The condition of this patient also improved and the palsy was not permanent.ConclusionsFCGM may be an effective treatment option in case of traumatic TMP. The procedure requires no hospitalization, and can be used to avoid traditional tympanoplasty.

Healing Human Moderate and Large Traumatic Tympanic Membrane Perforations Using Basic Fibroblast Growth Factor, 0.3% Ofloxacin Eardrops, and Gelfoam Patching.

The goal of this study was to evaluate the effects of basic fibroblast growth factor (bFGF), 0.3% ofloxacin eardrops (OFLX), and Gelfoam patching on the healing of human moderate and large traumatic tympanic membrane perforations (TMPs). A prospective, quasi-randomized, controlled clinical study. A University-affiliated teaching hospital. We performed a quasi-randomized prospective analysis between January 2010 and December 2014. All patients had traumatic TMPs covering areas >25% of the entire tympanic membrane. The closure rates, closure times, hearing gains, and rates of otorrhea in patients who underwent conservative observation, Gelfoam patching, topical bFGF application, and direct application of OFLX were compared. We ultimately included 185 patients. Closure rates did not significantly differ among the four groups (p = 0.257). Post-hoc multiple comparisons also showed that the closure rates did not differ between any two groups (p > 0.083). The mean closure times were 25.6 ± 13.32, 12.3 ± 8.15, 14.3 ± 5.44, and 13.97 ± 8.82 days for the observation, bFGF, Gelfoam patch, and OFLX groups, respectively. The closure times of the four groups differed significantly (p < 0.001). Post-hoc multiple comparisons showed that the differences between the observation group and each of the other groups were significant (p < 0.001). No other between- or among-group differences were significant (p > 0.0083). The findings of this study suggest that OFLX, bFGF, and Gelfoam patching accelerated the closure of human moderate and large traumatic TMPs. Hence, treatment of human traumatic TMPs should be revisited clinically. Topical application of OFLX may be recommended, because OFLX is more easily available and convenient than bFGF or Gelfoam patch for otology outpatients.

Use of a platelet-rich fibrin membrane to repair traumatic tympanic membrane perforations: a comparative study

Objectives: (1) To evaluate the effects of a platelet-rich fibrin (PRF) membrane in the repair of traumatic tympanic membrane (TM) perforations; and (2) to compare the use of a PRF membrane with the paper patch technique with regard to recovery rates, healing time, and correction of the mean air–bone gap.Methods: A randomized, prospective analysis was performed for 60 patients who were treated for traumatic TM perforations using one of the two methods. Closure rate, speed of healing, and hearing gain were compared between the PRF (Group 1) and paper patch (Group 2) groups.Results: Closure was obtained in 28 (93%) perforations in Group 1 and 25 (83%) perforations in Group 2 (p > 0.05). On day 10, full closure of the TM was observed in 24 (80%) patients in Group 1 and 16 (53%) patients in Group 2 (p < 0.05). The improvement in the mean air–bone gap was 14.1 dB in Group 1 and 12.4 dB in Group 2 on post-operative day 45 (p < 0.05).Conclusions: In comparison with the paper patch method, PRF, a new method, provided more rapid healing with more successful audiological results, and with no requirement for a second procedure.

A retrospective study of EGF and ofloxacin drops in the healing of human large traumatic eardrum perforation

ObjectiveWe evaluated the effects of epidermal growth factor (EGF) and ofloxacin otic drops on the healing of large human traumatic tympanic membrane perforations (TMPs). Study designCase series with chart review. SettingTertiary university hospital. MethodsRetrospective case review of patients with traumatic TMP larger than 25% of the TM seen between February 2007 and December 2008. Patients were stratified into EGF drops, ofloxacin drops, and observation groups. The closure rate, closure time, and hearing level were compared among the three groups at 6months. ResultsIn total, 120 patients met the inclusion criteria. The total closure rate was 89.2% (107/120) and the total mean closure time was 22.6±7.4days. The closure rates of perforation in the EGF, ofloxacin otic drops, and observation groups were 93.5%, 92.0%, and 82.2%, respectively. The closure rates among the three groups were not statistically different (p=0.19). The mean perforation closure times were 12.6±6.9, 12.9±5.1, and 35.7±9.2days for the EGF, ofloxacin otic drops, and observation groups, respectively. The average closure time in the observation group was significantly longer (p=0.01) than that in the EGF and ofloxacin otic drops groups. However, the closure times in the EGF and ofloxacin otic drops groups were not significantly different (p=0.84). ConclusionsThe study surprisingly found that both topical application of EGF and ofloxacin otic drops result in more rapid closure compared with spontaneous healing for human large traumatic TMPs. The benefit would be great as a shorter recovery time may reduce health care costs. Therefore, ofloxacin otic drops should be considered in clinics.

The effect of ofloxacin otic drops on the regeneration of human traumatic tympanic membrane perforations.

To investigate the effects of direct application of ofloxacin otic drops on human traumatic tympanic membrane perforations (TMPs). Prospective, sequential allocation, controlled clinical study. Tertiary university hospital. In total, 149 patients with traumatic TMPs were recruited. They were allocated sequentially to two groups: a conservative observation group (n = 75) and a ofloxacin drops-treated group (n = 74). The closure rate, closure time and rate of otorrhoea were compared between the groups at 6 months. In total, 145 patients were analysed. The closure rates of medium perforations between the groups were not significantly different (P = 0.35); however, the ofloxacin drops-treated group had a significantly shorter closure time for medium perforations than the observation group (P < 0.01). Additionally, the ofloxacin drops-treated group showed improvement in the closure rate of large perforations (P = 0.02) and a significantly shorter mean closure time (P < 0.01) than the observation group. However, purulent otorrhoea was not significantly different between the groups (P = 0.37). The present findings indicate that the moist eardrum environment resulting from topical application of ofloxacin drops shortened the closure time and improved the closure rate, but did not affect hearing improvement or increase the rate of middle ear infection of large traumatic TMPs. Thus, although traumatic TMPs tend to heal spontaneously, moist therapy can be considered for traumatic, large TMPs in the clinic.

Topical application of epidermal growth factor with no scaffold material on the healing of human traumatic tympanic membrane perforations.

We evaluated the effects of conservative treatment and topical application of epidermal growth factor (EGF) with no scaffold material on the healing of human traumatic tympanic membrane perforations (TMPs). Prospective, randomised clinical trial. A prospective analysis was performed between January 2015 and March 2015 for the treatment of human traumatic TMPs. The closure rate, closure time, hearing gain and rate of purulent otorrhoea were compared between the topical application of EGF and conservative treatment. In total, 97 patients were analysed. The total closure rates did not significantly differ between the observation and EGF groups (83.0% versus 92.0%, P = 0.182). The total average closure time in the observation group was significantly longer than in the EGF group (25.1 ± 10.5 versus 11.7 ± 5.2 days, P = 0.001). When the closure rate was evaluated according to perforation size, no significant difference was seen for medium or large perforations (P = 0.18 and 0.21, respectively). When closure time was evaluated according to perforation size, a significant difference was seen for medium and large perforations (P = 0.001). This study suggests that topical application of EGF with no scaffold material may significantly shorten the closure time of human traumatic TMPs. Such a shorter recovery time may lead to reduced healthcare costs. This alternative technique to a classic myringoplasty is particularly beneficial and suitable for the closure of large human traumatic TMPs.

Traumatic tympanic membrane perforation: An overview

Objectives: The purpose of this study was to determine the various etiologies of traumatic tympanic membrane (TM) perforations; their clinical presentation, observation and establish masterly inactivity as the main modality of management. Materials and Methods: A prospective study was performed on 350 cases of traumatic TM perforation in the Department of ENT, SKIMS Medical College, Srinagar from January 2010 to December 2014. Results: A total of 350 patients with the traumatic TM. Perforation was enrolled for this study. The group consisted of 231 male and 119 female patients. It affects all age groups with the highest incidence among middle age group. The right ear was involved in 94 (26.85%) patients, the left ear in 249 (71.14%) patients and bilateral ear involvement was seen in 7 (2%) patients. The type of trauma included compression injury in 243 (64.42%) patients, instrumental injury in 88 (25.14%) patients, and blast injury in 19 (5.42%) patients. Tinnitus was the most common complaint, followed by aural fullness, impaired hearing, otalgia, bleeding from ear and vertigo. 217 (62%) patients presented with conductive hearing loss in the range of 20–35 dB, 77 (22%) patients with 35 dB hearing loss, and 28 (8%) patients presented with no air-bone gap. Grade I perforation ( 50% TM involvement) was present in 38 (10.90%) patients. Complete healing was observed within 2–6 weeks in 172 (49.10%) patients and within 7–9 weeks in 112 (32.20%) patients. 35 (10%) patients showed complete healing within 10–12 weeks. The minimum time taken to heal was 21 days and maximum time 72 days. Complete healing was observed in 319 (91.10%) patients. The intervention was only performed when spontaneous healing failed to occur after observing the patients for 1 week and included tympanoplasty in 8 (2.30%) patients, trichloroacetic acid cauterization in 14 (4%) patients. Residual perforation was observed in 9 (2.5%) patients. Conclusion: In our experience, traumatic TM perforation is still very common. Slap, instrumentation, road traffic accident, and blast injuries are common etiologies seen. It affects all age groups. Tinnitus and hearing loss are commonest symptoms. The masterly inactivity should be religiously followed and unnecessary surgical intervention should be discouraged.

Direct application of bFGF without edge trimming on human subacute tympanic membrane perforation

ObjectiveTo investigate the feasibility of direct application of basic fibroblast growth factor (bFGF) without edge trimming on human subacute traumatic tympanic membrane perforation (TMP). MethodsA total of 29 patients with traumatic TMPs beyond 1month after trauma were enrolled. Patients were placed into two groups: an observation group (n=17) and a bFGF-treated group (n=12). The bFGF-treated group was treated by direct application of bFGF, in which the margin of the perforation was not trimmed. All patients were followed at least once per week until the perforation was completely closed or for up to 6months. The closure rate and closure time were estimated. ResultsAt 6months, 11/12 (91.7%) perforations achieved complete closure after bFGF treatment. The mean closure time was 18.1±11.4days (range=3–65days). Purulent otorrhea was found after treatment in five patients, but resolved after oral amoxicillin and ofloxacin ear drops. Of these five patients, four achieved complete closure. However, only 9/17 (52.9%) perforations achieved complete spontaneous closure in the observation group. FGF-treated groups had significantly improved closure rates compared to the observation group (91.7% vs. 52.9%, respectively, P=0.03). ConclusionsAlthough the margin of the perforation was not trimmed, direct application of bFGF on human subacute TMP was feasible, and it could significantly improve the closure rate of the subacute TMPs. The technique was simple and convenient. Thus, direct application of bFGF should be recommended pre-myringoplasty.

Comparative study on the effects of EGF and bFGF on the healing of human large traumatic perforations of the tympanic membrane.

We evaluated the effects of epidermal growth factor (EGF) and basic fibroblast growth factor (bFGF) on the healing of large traumatic tympanic membrane perforations (TMPs). Prospective clinical study. Tertiary university hospital. A randomized, prospective analysis was performed between June 2013 and August 2014 on the treatment of traumatic TMPs larger than 25% of the TM. Closure rate, closure time, hearing gain, and rate of otorrhea were compared between EGF and bFGF groups, as well as to an observation-only group. Final analysis was performed on 86 patients at 3 months. The closure rates of perforation in the EGF, bFGF, and observation groups were 86.2%, 89.3%, and 72.4%, respectively. The closure rates in the EGF and bFGF groups were 14% to 17% higher than in the observation group, although the difference was not statistically significant for the total closure rate among the three groups (P = 0.200). The average closure time was significantly longer (P < 0.01) in the observation group than in the EGF and bFGF groups. However, the closure times in the EGF and bFGF groups were not significantly different (P = 0.92). In addition, differences in purulent otorrhea rates among the groups were not statistically significant (P = 0.82). Both EGF and bFGF can accelerate the closure of human large traumatic TMPs. The healing outcomes among the two growth factors were not significantly different.