Traumatic Traumatic Tympanic Membrane Perforations Research Articles

Risk factors affecting human traumatic tympanic membrane perforation regeneration therapy using fibroblast growth factor-2

Objective: The use of growth factors to achieve closure of human traumatic tympanic membrane perforations (TMPs) has recently been demonstrated. However, pretreatment factors affecting healing outcomes have seldom been discussed. The objective of this study was to evaluate pretreatment factors contributing to the success or failure of healing of TMPs using fibroblast growth factor-2 (FGF-2). Design and participants: A retrospective cohort study of 99 patients (43 males, 56 females) with traumatic TMPs who were observed for at least 6 months after FGF-2 treatment between March 2011 and December 2012. Eleven factors considered likely to affect the outcome of perforation closure were evaluated statistically using univariate and multivariate logistic regression analysis. Interventions: Each traumatic TMP was treated by direct application of FGF-2. Main outcome measures: Complete closure versus failure to close. Results: In total, 99 patients were analyzed. The total closure rate was 92/99 (92.9%) at 6 months; the mean closure time was 10.59 ± 6.81 days. The closure rate did not significantly differ between perforations with or without inverted edges (100.0% vs. 91.4%, p = 0.087), among different size groups (p = 0.768), or among different periods of exposure to injury (p = 0.051). However, the closure rate was significantly different between the high- and low-dose FGF-2 groups (85.0% vs. 98.3%, p = 0.010) and between perforations where the umbo or malleus was or was not involved in perforation (85.4% vs. 98.3%, p = 0.012). Additionally, univariate logistic regression analysis tests showed that it was difficult to achieve healing of these perforations with a history of chronic otitis media or residual TM calcification (p = 0.006), the umbo or malleus was involved in perforation (p = 0.038), and with a high dose of FGF-2 (p = 0.035) compared with control groups. Multivariate logistic regression analysis showed that only a history of chronic otitis media and residual TM calcification and perforation close to the umbo or malleus were associated with non-healing of the TM perforation (p = 0.03 and p = 0.017, respectively) with relative risk factors. Conclusions: Direct application of FGF-2 can be used in all traumatic TMPs, the size of the perforation and inverted edges did not affect the closure rate, and the most beneficial dose was sufficient to keep the residual eardrum environment moist, but without adding liquid. Additionally, multivariate logistic regression analysis revealed that a large perforation was not a major risk factor for nonhealing of TM perforations. However, a history of chronic otitis media, residual TM calcification and involvement of the umbo or malleus in perforation were significant risk factors.

Evaluation of the optimum time for direct application of fibroblast growth factor to human traumatic tympanic membrane perforations

Objective: The aim of this study was to determine the optimum time for direct application of basic fibroblast growth factor (bFGF) on large traumatic tympanic membrane perforations (TMPs). Study design: Prospective clinical study. Setting: Tertiary University Hospital. Methods: Ninety-three patients, with traumatic TMPs greater in extent than 25% of the entire tympanic membrane, were randomized into observation and bFGF-treated groups (∼0.2–0.25 mL of bFGF solution was applied directly onto the TM once daily and continued until the perforation closed). Initial visit times were subcategorized into perforation durations of ≤3 and >3 days, thereby rendering two subgroups, as follows: A and B in the observation group; and C and D in the bFGF-treated group. The closure rate and mean closure time were evaluated after 6 months. Results: Eighty-six patients were finally analyzed. After 6 months, the bFGF-treated group exhibited a significantly higher total closure rate (97.8 versus 82.5%, p < 0.05) and a shorter mean closure time (12.5 ± 3.4 versus 34.0 ± 5.9 days, p < 0.05) compared with the spontaneous healing group. In addition, in the observation group, visiting time was not associated with differences in closure rate (p > 0.05) and mean closure time (p > 0.05), between the A and B subgroups. Similarly, in the bFGF-treated group, visiting time was not associated with differences in closure rate (p > 0.05) between the C and D subgroups. However, the D subgroup was characterized by significantly shortened mean closure time compared with the C subgroup (p < 0.05). Conclusions: This study shows the beneficial effect of bFGF on human traumatic large TMPs when applied after the 3rd day post-injury had passed (i.e. during the proliferative stage of wound healing). The procedure can not only significantly shorten closure time but can also reduce both the clinical administration duration and occurrence of side-effects associated with bFGF.

Effects of basic fibroblast growth factor dose on traumatic tympanic membrane perforation

Objective: To compare the healing outcomes of higher and lower doses of basic fibroblast growth factor (bFGF) on human traumatic tympanic membrane perforation (TMP). Study design: Prospective clinical study. Methods: All patients with traumatic TMP were treated by direct application of bFGF, and were sequentially allocated into one of two groups: lower-dose group (2–3 drops of bFGF solution daily, approximately 0.1–0.15 mL) and higher-dose group (5–6 drops of bFGF solution daily, approximately 0.25–0.3 mL). The results of closure rate, closure time, and rate of otorrhea between the higher- and lower-dose groups were compared at 3 months. Results: In total, 126 patients were included in this study. The higher-dose group showed significantly improved purulent otorrhea rate compared with the lower-dose group (p < 0.01) for perforations of the same size, although the closure rate of the middle-sized perforations did not differ significantly between higher- and lower-dose groups (p > 0.05). However, the lower-dose group had a significantly shorter closure time of 5 d compared with the higher-dose group (p < 0.05). In addition, although the lower-dose group showed shorter healing times (about 3 d) compared to the higher-dose group for large-sized perforations, the dosage of bFGF did not significantly affect the large-sized perforation closure rate (p > 0.05) or closure time (p > 0.05). Nine large-sized perforations with secondary purulent otorrhea achieved complete closure, with closure times of 7–25 (14.2 ± 5.8) d. Conclusion: This study suggested that continued daily application of a lower dose of bFGF not only shortens the closure time of human traumatic TMP but also avoids secondary purulent otorrhea.

Comparison of the healing mechanisms of human dry and endogenous wet traumatic eardrum perforations

This prospective study aimed to assess the spontaneous healing mechanisms of human dry and endogenous wet traumatic tympanic membrane perforations (TMPs). A total of 106 patients with traumatic TMPs were included. Based on the presence or absence of endogenous bloody or watery exudates on the residual eardrum and/or at perforation margins, 73 perforations were classified as dry perforations and the remaining 33 as endogenous wet perforations. In 65 of the 73 dry perforations, centripetal migration of an epithelial layer was the first event seen during the spontaneous healing process, which was followed by growth and migration of the other two layers (i.e., the fibrous layer and the inner mucous layer). In the remaining eight dry perforation cases, outward epithelial migration was observed on the side of the perforation edge. In the 33 endogenous wet perforations, closure seemed to start with growth of the fibrous layers which were then covered by the migrating epithelium. Within the first week after injury, only 16.3 ± 6.7 % of the perforation area healed in the dry perforation cases, whereas 82.2 ± 13.9 % of the perforation area healed in the wet perforation cases; the difference was significant (P < 0.01). These observations suggest that different mechanisms may be involved in spontaneous healing of dry and wet traumatic TMPs in humans, thereby resulting in differences in healing time and healing outcome.

Impact of Evolution of the Eardrum Bridge on the Healing Process of Traumatic Eardrum Perforation

Objectives: Characterize the otoendoscopic features of traumatic tympanic membrane perforations (TMPs) with an “eardrum bridge” and evaluate the evolution of the eardrum bridge during the spontaneous healing process. Methods: Data for 427 patients with barotrauma-associated traumatic TMPs who met the case selection criteria were retrieved and categorized into two groups: those with and those without an eardrum bridge. Results: Of the 427 patients with traumatic TMPs during the two-year study period between January 2006 and December 2007, only 36 (8.4%) had an eardrum bridge. For small-sized perforations, the overall closure rate was significantly different (100% versus 87.7%, P=0.03) between those with and without an eardrum bridge. However, the average closure time was not significantly different (21.2 versus 26.8 days, P&gt;0.05), although the mean closure in cases with an eardrum bridge was shortened by 5 days compared to that in cases without an eardrum bridge. For medium and large perforations, statistical analysis was not performed due to the much smaller number of cases with eardrum bridges. Conclusions: Eardrum bridge with traumatic TMP can result in necrosis, migration of stratified epithelium, and epithelium proliferation during the healing process. However, the eardrum bridge seems to improve the healing rate of traumatic perforations.

Healing Mechanisms of Human Traumatic Tympanic Membrane Perforations

Objectives: Prospectively assess the healing mechanism of human traumatic tympanic membrane perforation (TMP). Methods: The spontaneous healing process of 20 patients with traumatic TMPs was photographed and analyzed. Results: Of the 20 patients with traumatic TMPS, 16 suffered dry perforations and four had wet perforations. Of the 16 dry perforations, in 13 patients, centripetal migrating epithelium was the first layer to close the perforation, followed by the fibrous layer. In 3 of 16 dry perforations, outward epithelial migration was observed on the side of perforation edge. Of the four wet perforations, granulation tissue formation of a fibrous layer was the first layer to close the perforation, after which it was covered by migrating epithelium. Additionally, within 1 week after injury, healing of dry perforations was slow, the estimated percentage not exceeding 30%, while that of wet perforations was significantly faster; the estimated percentages were 60-95%. Conclusions: The healing mechanism of human traumatic TMPs may be related to the eardrum condition. Centripetal migrating epithelium from the proliferation center plays a crucial role in healing of dry perforations. In contrast, granulation tissue formation from the connective tissue layer plays an important role in healing of wet perforations.

Natural evolution of an eardrum bridge in patients with a traumatic eardrum perforation

Although the “eardrum bridge” of traumatic tympanic membrane perforations (TMPs) is very little seen, the underlying natural evolution during the healing process are still unknown.The aim of this retrospective study was to evaluate the natural evolution of the “eardrum bridge” of TMPs. The data for 36 patients with barotrauma-associated traumatic TMPs with an “eardrum bridge” between January 2006 and December 2007 were retrieved. The eardrum bridge was completely liquefied due to infection in one patient. The bridge gradually became necrotic and incorporated into the new eardrum in four patients, and the healed eardrum formed a retraction pocket. In nine patients, epithelial hyperplasia occurred on both sides of the eardrum bridge at the edges, and the bridge became incorporated into the new eardrum, which became very thin over time. However, in 22 patients, the eardrum bridge gradually became necrotic, finally forming a yellow crust-like substance and migrating to the external auditory canal (EAC); it was not incorporated into the new eardrum. The closure of the perforation depended on stratified epithelial migration at the perforation edges near the eardrum bridge, resulting in a normal morphology of the healed eardrum. The present study shows that the eardrum bridge has a different natural evolution during the healing process in patients with a TMP. Most eardrum bridges gradually became necrotic and migrated toward the EAC, and stratified epithelial migration occurred at the perforation edges near the eardrum bridge and closed the perforation. However, a few eardrum bridges gradually became necrotic or developed epithelial hyperplasia, then became incorporated into the new eardrum, resulting in the formation of a retraction pocket and the development of atrophy. Thus, long-term follow-up and histological examination of a larger sample is necessary.

Spontaneous Healing of Traumatic Eardrum Perforation

To characterize the otoendoscopic features of traumatic tympanic membrane perforations (TMPs) with outward-migrating epithelium at the perforation edges and to evaluate the spontaneous healing outcome of this type of perforation. Case series with chart review. Tertiary university hospital. The clinical records of traumatic TMP patients who met the case selection criteria were retrieved and categorized based on the documented migration pathways of the proliferating epithelial cells at the perforation margins into 2 groups: centripetal migration and outward migration. The demographic data and spontaneous healing outcomes (ie, healing rate and time) of these 2 types of TMP were analyzed using the chi-square test or t-test. The otoendoscopic features were characterized. In all, 122 cases were analyzed. During the spontaneous healing process, perforations were associated with centripetal epithelial cell migration in 87 (71.3%) cases and with outward epithelial cell migration in 35 (28.7%) cases. The overall perforation closure rates at the end of 6 months were 97% and 94% for the centripetal and outward migration groups, respectively (P > 0.05). The average perforation closure times were 18.4 ± 3.7 and 37.6 ± 9.2 days, respectively (P < 0.05). Although the outward epithelial migration did not affect the overall perforation spontaneous healing rate, it alone could not close the perforation. The prerequisite for eardrum healing is that the outward epithelium migration pattern evolves into a centripetal migration pattern. Consequently, outward epithelial migration prolonged substantially the time to traumatic eardrum perforation closure.

Traumatic tympanic membrane perforations: a study of etiology and factors affecting outcome

ObjectiveThe purposes of this study were to determine the factors involved in the spontaneous healing and to profile the various etiologies of traumatic tympanic membrane (TM) perforation. MethodsA retrospective review was performed on 729 cases of traumatic TM perforation diagnosed in the emergency department and outpatient clinic from January 2007 to March 2011. ResultsA total 641 patients with traumatic TM perforations were enrolled in the study. The group consisted of 320 male and 321 female patients with a mean age of 33.6 years (3–79 years). The types of trauma included compression injury (554 patients), blast injury (55 patients), and instrumental injury (32 patients). The causes of conflict by a slap or a fist were spouse or lover (52%), parents and sibling (3%), school teachers (4%), schoolmate (12%), state police and prisoner (7%), and blow against the ear during street fight (22%). Of the 641, 137 were lost during follow-up; of the remaining 504, perforations closed spontaneously in 451 (89%), within a mean of 27.4 days. Wet perforations with bloody or watery discharge significantly improved the healing rate (P < .01) and shortened the average perforation closure time (P < .01), as compared with dry perforations. Although the perforation that involved malleus or umbo damage did not significantly affect the healing rate (P > .05), a significantly prolonged closure time (41.6 vs 23.8 days) was observed as compared with no damage. However, the curled edges did not also affect the outcome of spontaneous healing; the healing rate was 91% and 88% (P > .05), and the average closure time was 28.1 and 26.7 days (P > .05), respectively, for with and without curler edges. By perforation size, the overall healing rate was 92% and 54% (P < .01), and the average closure time was 22.8 and 47.3 days (P < .01), respectively, for small and larger perforations. Moreover, 7 patients had neomembrane formation on follow-up, 2 developed cholesteatoma, 1 developed tympanosclerosis, and 1 developed facial paralysis. ConclusionIn our experience, domestic violence and street fight were the most common causes of the traumatic TM perforation. Traumatic TM perforations have excellent prognosis. However, preexisting tympanosclerosis and the perforation that involved malleus or umbo damage could lengthen the healing time of perforation, Wet perforations with bloody or watery discharge accelerate the healing, but the curled edges did not affect the outcome of spontaneous healing.

Role of topical heparine in healing of traumatic tympanic membrane perforations

Background: Traumatic tympanic membrane (TM) perforations may arise from instruments such as cotton swabs, bobby pins, and sticks, skull fractures, acid burns and welding or metal working slag burns. Pressure induced perforations can occur after loud noise and explosions, open palm trauma (slapping), or changes in ambient pressure that occurs during flying and underwater diving. In case of traumatic perforation, some observation time is recommended before surgical intervention. In the recent years, various substances like hyaluronic acid, growth factors, pentoxyfyline and heparin were used for treating TM perforations. Objective: To assess effectiveness of topical heparin in healing of traumatic TM perforations. Materials and Methods: We studied 73 patients of age group 20-35 having traumatic TM perforations due to various injuries and present to our clinic within one week after injury. These patients where put in two groups, control group which contained 36 patients, and study group which contained 37 patients. Control group patients where treated with systemic antibiotics and nasal decongestants where as study group patients where treated in addition to systemic antibiotics and nasal decongestants by topical heparin. Follow-up was done for period of 21 days and improvement in time of healing was compared. Results: In our study, there was statistically significant improvement ( P Conclusion: The present study suggest that topical heparin has significant role in healing of traumatic TM perforations, especially when used within 3 days of injury.

Effect of treatment at different time intervals for traumatic tympanic membrane perforation on the closure

Conclusion: Treatment of traumatic tympanic membrane (TM) perforation with everted or involute edge flaps at different time intervals within 1 week after the injury did not affect the perforation closure rate and mean closure time. Objective: To retrospectively analyze the effect of treatment at different time intervals for traumatic tympanic membrane perforation with gelatin sponge patch and edge approximation plus gelfoam patching. Methods: Patients with traumatic TM perforation visited at different days since the injury for medical treatment (1, 2, 3, 4, and 5–7 days post trauma). These patients were treated with the following prominent methods of treatment: gelatin sponge patch treatment and edge approximation plus gelfoam patching. Measurement indicators were perforation closure rate and mean closure time at 3 months. Results: In the group treated with the gelatin sponge patch technique, the patients sought medical treatment at different time intervals since the injury. Accordingly, the outcome of the treatment varied in terms of the perforation closure rates achieved in different patients in this group. The respective perforation closure rates were 100%, 100%, 96%, 94%, and 89% in accordance with the time interval at which the patients were treated since the injury. The results were not significantly different when compared by statistical analysis (p > 0.05); the mean closure times in each of the different sets of cases in this group were calculated and the following values were reported: 7.1 ± 2.3, 8.2 ± 1.6, 8.7 ± 1.2, 9.2 ± 3.1, and 10.7 ± 3.9 days. On the other hand, in the edge approximation plus gelfoam patching group, the perforation closure rates were 100%, 97%, 96%, 97%, and 94%, respectively. This was in accordance with the time elapsed since the injury for the patients who visited the hospital on different days. Statistical analysis confirmed that the perforation closure rates for the different cases of this group did not have any significant difference (p > 0.05); the mean closure times were 7.6 ± 1.9, 7.9 ± 2.2, 9.2 ± 2.8, 8.5 ± 3.6, and 11.2 ± 4.1 days, respectively, indicating that differences were not significant even in terms of mean closure rates for the different cases of this group (p > 0.05).

Repair of Large Traumatic Tympanic Membrane Perforation with a Steri‐Strips Patch

To investigate the effects of the Steri-Strips patch (3M) on the treatment of large traumatic tympanic membrane perforations (TMP). Prospective, randomized, controlled. Tertiary university hospital. A randomized prospective analysis was performed between February 2009 and January 2011 for the treatment of traumatic TMP larger than 50% of the entire tympanic membrane. The results of closure rate, closure time, hearing gain, and rate of otorrhea between conservative observation, paper patching, and Steri-Strips patching groups were compared. In total, 87 patients were analyzed in this study. The closure rates of the perforations in the Steri-Strips patching, paper patching, and observation groups were 93.3%, 84.2%, and 78.9%, respectively. There was no statistically significant difference in tympanic membrane closure rate between the 3 groups. The Steri-Strips technique decreased the need for repeat procedures. Overall, the Steri-Strips and paper patching groups showed shorter healing times compared with the observation group. However, there was an increased rate of otorrhea in the Steri-Strips group compared with the observation group. Steri-Strips patching reduced the healing time and need for repeat procedures in patients with large traumatic TMPs. However, the occurrence of otorrhea was significantly more common in patients treated with the Steri-Strips technique.