Traumatic Tympanic Membrane Perforations Research Articles

Ayurvedic Management of Traumatic tympanic membrane perforation

Traumatic tympanic membrane perforations are common in Otolaryngological practice. These perforations can be due to direct penetrating trauma, infections or due to eustachian tube disorders. These perforations can lead to reversible high frequency deafness, tinnitus and vertigo. Small perforations heal spontaneously within three months after the injury while large perforations are treated with myringoplasty. This is a case report of 35year old female patient who presented to Shalakya OPD with complaints of sudden onset of earache and reduced clarity of hearing in left ear, since 7 days. The tympanic membrane was ruptured. While compairing the size of perforation relative to circumference of the tympamic membrane, it was observed to be a large sized perforation affecting 50% of tympamic membrane. Large sized perforations are usually considered non healing as it exert influence on the malleus and umbo at tympanic membrane insertion and would interrupt the sound conducting mechanism. She was managed conservatively with Ayurveda treatment. Karnalepa applied over the pre auricular and mastoid region makes the healing fast and effective. Karnapichu, the modified form of karnapoorana provides a much larger skin contact time with controlled release of drugs.The case report shows the effect of local and systemic medication in the form of Murivenna karnapichu. The healing of tympanic membrane occurred within one month of follow up.

Local Alpha1-Antitrypsin Accelerates the Healing of Tympanic Membrane Perforation in Mice.

Most tympanic membrane (TM) perforations heal spontaneously, but 10%-20% remain chronic and might lead to impaired hearing and recurrent middle ear infections. Alpha1-antitrypsin (AAT) is a circulating tissue-protective protein that is elevated under inflammatory conditions and is currently indicated for genetic AAT deficiency. Recently, AAT has been shown to promote tissue remodeling and inflammatory resolution. This study aimed to examine the effects of local clinical-grade AAT treatment on tissue repair in a mouse model of acute traumatic TM perforation. Wild-type mice underwent unilateral TM perforation and were either left untreated or treated locally with human AAT (9 × 10-3 mL at 20 mg/mL on days 0, 1, and 2; n = 15/group). The perforations were evaluated macroscopically on a serial basis. Mice were sacrificed on various days post-injury, and TMs were excised for gene analysis by RT-PCR. There were no adverse reactions in hAAT-treated ears throughout the study period. Compared with untreated animals, TM closure occurred earlier in the treated group (days until full closure, median: 4 and 9, respectively). According to gene expression analysis, VEGF, TGFβ, and collagen-5A1 were induced earlier in AAT-treated mice (day 4-5 compared with day 9). Additionally, IL-10 expression levels were higher and IL-6 levels were lower in treated versus untreated mice. A local tissue environment rich in AAT promotes early tissue repair in a perforated TM model both macroscopically and molecularly. Studies are underway to examine TM functionality and recombinant AAT formulations for micro-dosing in the format of a single local application. NA Laryngoscope, 2024.

Traumatic tympanic membrane perforations.

Traumatic tympanic membrane perforations.

Causes and Characteristics of Traumatic Tympanic Membrane Perforation in a Tertiary Care Hospital

Background: Due to human violence, perforation of the tympanic membrane is a frequent occurrence all over the world. The abrupt increase in air pressure in the external auditory canal is the pathophysiology of traumatic tympanic membrane perforation. Objective: To assess the causes and characteristics of traumatic Tympanic Membrane perforation in a tertiary care hospital Methodology: The current study was cross sectional study, conducted at the ENT Department of Sahara Medical College Narowal from January 2022 to July 2022. All the patients were examined by a sing ENT specialist and data was recorded on a pre-designed performa. All the analysis of data was done by IBM SPSS version 23. Results: In the current study, totally 80 patients were enrolled. There were 50 (62.5%) male patients while female patients were 30 (37.5%). The mean age in our study was 28 (4.29) years. The most common type of tympanic membrane perforation was slap in 56 (70%) patients followed by blast injury in 8 (10%) patients. On left side of ear, perforation of the Tympanic membrane was observed in 39 (48.75%) patients. Based on number of perforation, single perforation was observed in 72 (90%) patients while multiple perforations were observed in 8 (10%) patients. Conductive hearing loss was observed in 62 (77.5%) patients and Mild Hearing Loss was observed in 44 (55%) patients. Conclusion: Young males, particularly those between the ages of 18 and 30, often have traumatic tympanic membrane perforation. The most frequent cause of traumatic perforation was slap, which affects the left ear more frequently than the right ear. The most common type of hearing loss was conductive, and mild. Keywords: Causes; characteristics; Tympanic Membrane perforation

Comparative study of fibroblast growth factor 2 and ofloxacin ear drops for repairing large traumatic perforations: A randomized controlled study

ObjectiveThe objective of this study was to compare the healing outcome of fibroblast growth factor 2 (FGF2), ofloxacin ear drops (OFLX) and spontaneous healing for repairing large traumatic tympanic membrane (TM) perforations. Material and methodsA total of 75 traumatic large perforations with >1/4 of TM were randomly divided into FGF2 (n = 25), OFLX (n = 25), and spontaneous healing (n = 25) groups. The closure rates, closure times, and hearing gains were compared at 3 months. ResultsAt 2 weeks after treatment, the closure rate was 95.8 % in the FGF2 group, 96.0 % in the ofloxacin ear drops group, and 14.3 % in the spontaneous healing group (P < 0.01), respectively. At 3 months after treatment, the closure rate was 100 % in the FGF2 group, 100 % in the OFLX group, and 85.7 % in the spontaneous healing group, no among-group differences were significant (P > 0.05). The mean closure time was 9.69 ± 2.46 days in the FGF2 group, 9.45 ± 2.32 days in the OFLX group, and 30.94 ± 8.95 days in the spontaneous healing group (P < 0.01). The mean ABG was 10.37 ± 2.51 dB for the FGF2 group, 11.01 ± 1.31 dB for the OFLX group, and 10.86 ± 1.94 dB for the spontaneous healing group, no significant difference was found among three groups (P > 0.05). ConclusionsThis study suggested that both FGF2 and OFLX significantly shortened the mean closure time and improved the closure rate compared with spontaneous healing for repairing large traumatic perforations, while the healing outcome wasn't significantly different among FGF2 and OFLX groups.

Traumatic Perforation – Etiology, Outcome and Factors Affecting the Outcome

INTRODUCTION&#x0D; Traumatic tympanic membrane perforation is the most common type of trauma – induced otologic dysfunction. The study is aimed to evaluate factors affecting healing of truamatic tympanic membrane perforation after 12 weeks.&#x0D; MATERIAL AND METHODS&#x0D; A prospective observational study conducted at UCMS, Bhairahawa, Nepal. Sixty patients with traumatic tympanic membrane perforation were evaluated on the basis of causes of trauma, symptoms, otoscopic examination, size of perforation and other factors affecting the outcome of perforation. Healing status of tympanic membrane was assessed 12-week post injury.&#x0D; RESULTS&#x0D; The age of the patients ranged from 4-79 years with mean age (years) of 27.84 ± 13.16. Otalgia was seen in 36 (60%) followed by hearing loss 21 (35%) and least common was vertigo 2 (3%). Most common etiology for injury was ‘Slap’(30%) followed by fall injury and physical assault excluding slap with each comprising 16%. Number of patients with small, medium and large perforations were 27 (45%), 21 (35%) and 12 (20%) respectively.&#x0D; &#x0D; After 12 weeks, 46 (77%) cases had healed perforation with best healing seen in younger patients having age group 11-40 years (26.28±13.5) and least in age group &gt;60 years (52±25.11 ) with p value of 0.01. 97% cases of smaller perforation had healed tympanic membrane whereas in larger perforation healing was observed in only 42 % cases.&#x0D; CONCLUSION&#x0D; Age, size of perforation, types of traumas have significant effect on outcomes of spontaneous healing. With cautious care and&#x0D; strong aural precautions, the prognosis of tympanic membrane perforation spontaneous healing is favourable.&#x0D;

Clinical Outcome and Etiologies of Traumatic Tympanic Membrane Perforation

Clinical Outcome and Etiologies of Traumatic Tympanic Membrane Perforation

The Effect of site of tympanic membrane perforation on hearing

Tympanic membrane(TM) perforation is one of the most common causes of hearing impairment. Apart from conduction of sound waves across the middle ear, the tympanic membrane, also sub-serves a protective function to the middle ear cleft and round window niche. The aim of the study is to determine the effect of the site of the tympanic membrane perforation on hearing. Seventy-eight patients with perforated tympanic membranes were included in the study.They all have TM perforation due to recurrent or chronic otitis media. Patients with traumatic TM perforation were excluded from the study. There were 47 males (46.5%) and 54 females (53.5%). Twenty patients had left ear perforation, 35 patients had right ear perforation, and 23 patients had bilateral perforations. Each ear was taken as a case, so the total number of the perforated ear drums was 101. The age ranged from 13- 56 with the mean of age was (31.64 ± 13.249) years. The TM perforation was examined and photo image was taken with the aid of the endoscope. Controls were 55 patients with a mean age 30.73 ±12.09 (range 14-53) years. Male controls were 34 (61.8%), and 21 female controls (38.2%). There is a positive correlation between site of TM perforation and hearing level, air bone gap, low frequency hearing level and high frequency hearing level. As a conclusion, there is a positive relationship between the site of TM perforation and hearing level being more in the posterior-superior and inferior parts.

Effect of the size of tympanic membrane perforation on hearing

Tympanic membrane (TM) perforation is one of the most common causes of hearing impairment. Apart from conduction of sound waves across the middle ear, the tympanic membrane, also sub-serves a protective function to the middle ear cleft and round window niche. It has been established that the larger the perforation on the tympanic membrane, the greater the decibel loss. The aim of this study is to determine the effect of the size of the tympanic membrane perforation on hearing. The study was conducted at Al-Jumhoori teaching hospital during march 2011 to march 2012. Seventy-eight patients with perforated tympanic membranes were included in the study.They all have TM perforation due to recurrent or chronic otitis media. Patients with traumatic TM perforation were excluded from the study. There were 47 males (46.5%) and 54 females (53.5%). Twenty patients had left ear perforation, 35 patients had right ear perforation, and 23 patients had bilateral perforations. Each ear was taken as a case, so the total number of the perforated ear drums were 101. The age ranged from 13- 56 with the mean of (31.64 ± 13.249) years. The TM perforation was examined and photo image was taken with the aid of the endoscope, and the percentage of the perforation was measured from the whole area by using a special Microsoft (infomap). Controls were 55 patients with a mean age 30.73 ±12.09( range 14-53) years. Male controls were 34 (61.8%), and 21 female controls(38.2%). There was a highly significant correlation between size of TM perforation with the hearing level, air bone gap, high frequency hearing loss and low frequency hearing loss. As a conclusion, there is strong relationship between the size of TM perforation and the hearing level, air-bone gap and both the low frequency and the high frequency hearing level and air-bone gaps.

Factors Influencing the Outcome of Spontaneous Healing of Traumatic Tympanic Membrane Perforation: A Clinical Prospective Observational Study.

This is a prospective study of 70 patients with traumatic tympanic membrane perforation between January 2019 and December 2022. Inclusion and exclusion criteria applied and results interpreted. Traumatic TM affects all age groups with a mean age of 27.94 ± 4.76years.Traumatic TM affects all age groups with a mean age of 27.94 ± 4.76 years, with the highest incidence among the middle-aged groups 61.4%. The male-to-female ratio was found to be 1.9:1, with high predominance among male patients (65.7%) with a frequency of 57.1% forslap injury group in our study contrary to others. Spontaneous healing was observed in 88.6% over a follow-up period of 12 weeks in this study. Our study has not shown that associated comorbidities influence healing (P = 0.550). About 45.5% Marginal perforations have not healed in 12 weeks follow-up period as compared to central perforations 5.1%. There is a high predominance of TM perforation among male patients in our study may be attributed to activity. Spontaneous healing is more common. Duration of healing was significantly affected by the size of the perforation with longer duration for large perforations and vice versa. It is observed in this study that the duration of spontaneous healing is longer in blast injuries when compared to other kinds of injuries. A significant proportion of marginal perforations that have not healed in our study may be attributed to annular ligament involvement.

Intratympanic membrane cholesteatoma after traumatic tympanic membrane perforation: a case report

BackgroundIntratympanic membrane cholesteatoma presents as an asymptomatic, white, round mass on the tympanic membrane, and is usually detected incidentally in children.Case presentationA 12-year-old Korean boy visited our otorhinolaryngology clinic for a whitish mass on the right tympanic membrane. He had a history of traumatic tympanic membrane perforation in the right ear that had occurred 1 year prior, which had healed well with a paper patch placement. The mass was completely removed under local anesthesia during surgery with a microscope. The mass was on the outer epithelial layer of the right tympanic membrane and did not invade the middle fibrous and inner mucosal layers. Cholesteatoma was diagnosed on the basis of histopathology.ConclusionIntratympanic membrane cholesteatoma may not induce symptoms or invade the middle ear because it can grow outwards into the external auditory canal. However, intratympanic membrane cholesteatoma can grow over time, and then after growth, it can compress the tympanic membrane and advance into the middle ear, which can cause symptoms such as hearing loss. Intratympanic membrane cholesteatoma in children should be carefully evaluated and followed, and surgical removal should be considered, even for asymptomatic cases, to minimize potential damage and hearing loss.

Comparison of the effect of Triticum Vulgare and Hyperici Oleum on healing in traumatic membrane perforation: an animal study

BackgroundTraumatic tympanic membrane (TM) perforations usually heal spontaneously. The aim of this study was to investigate whether the topical application of Triticum Vulgare (TV) in experimentally induced traumatic TM perforations in the rats has a positive effect on wound healing process.MethodsThe rats were randomly assigned to four experimental groups. Drugs were introduced twice a day for 7 days. On the 7th day, specimens were sent for histological examination.ResultsMean values found in group NC in terms of epithelial regeneration mean scores are as follows: fibroblast and collagen density, neovascularization, and density of inflammation cells were lower than all groups (p < 0.05).It was found that reepithelization on the post-perforation 7th day was better in the HO group than the TV group. In terms of the subepithelial fibroblast cells, density of collagen fibers, formation of new veins, and inflammatory cell accumulation, it was observed that the group TV was better than the group HO.ConclusionThis is the first study investigating the potential curative role of TV in an experimental rat model of tympanic membrane perforation. Considering these findings, it is concluded that TV can be more effective than HO on wound healing in TM perforation.

Healing large Traumatic Tympanic Membrane Perforations Using Vaseline Gauze and Gelfoam Patching Alone.

The aim of this study was to evaluate the effect of vaseline gauze (VG) patching on the treatment of large traumatic perforation of tympanic membrane (TM). 90 patients with traumatic perforation larger than 25% of the TM were randomly allocated into the control group of observation only, VG group, and Gelfoam patch alone group. The closure rate and closure time among the 3 groups were compared at 3 months. In total, 82 large traumatic perforations were analyzed in this study. The closure rates in the control, VG, and gelfoam patch groups were 84.6%, 100.0%, and 89.3%, respectively (P = 0.637). Post-hoc multiple comparisons showed that the difference between the control and VG groups was significant (P = 0.047), but the difference wasn't significant between gelfoam alone and control groups (P = 0.699) or VG groups (P = 0.236). The mean closure times were 5.41 ± 1.47, 2.14 ± 0.93, and 3.00 ± 0.62 weeks for the control, VG, and gelfoam patch groups, respectively (P < 0.001). Post-hoc multiple comparisons showed that the difference was significant between the control and VG groups (P < 0.001) or gelfoam alone group (P < 0.001) or VG and gelfoam groups (P < 0.05). VG improved the closure rate and shortened the closure time compared with observation only, which could be an effective patch material for repairing traumatic lager perforations in the outpatient setting, which is readily available and convenient.

Management for traumatic tympanic membrane perforation: a case series

Management for traumatic tympanic membrane perforation: a case series

A Case of Traumatic Tympanic Membrane Perforation Caused by &lt;i&gt;Kendo&lt;/i&gt;

A Case of Traumatic Tympanic Membrane Perforation Caused by &lt;i&gt;Kendo&lt;/i&gt;

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

With and without exogenous biological scaffolds for repairing traumatic perforations of tympanic membrane: Randomized clinical trials

ObjectiveThe objective of this study was to compare the efficacy of ofloxacin ear drops, vaseline gauze (VG) and dry gelfoam alone on the large traumatic perforations of tympanic membrane (TM). Material and methodsA randomized prospective analysis was performed for the treatment of traumatic perforation larger than 25 % of the entire TM. The closure rate, closure time, and hearing gain between ofloxacin ear drops, VG and gelfoam alone groups were compared at 3 months. ResultsFinal analysis was performed on 70 patients. The closure rates of perforation in the ofloxacin ear drops, VG, and dry gelfoam patch groups were 100.0 %, 92.0 %, and 87.5 %, respectively (P = 0.41).The mean closure times were 8.67 ± 3.1, 10.65 ± 4.2, and 14.33 ± 7.5 days for the ofloxacin ear drops, VG, and gelfoam patch alone groups, respectively. The closure times among the 3 groups were significantly different (P = 0.003). In addition, there was a significant difference between the ofloxacin ear drops and gelfoam patch alone groups with regard to closure time (P = 0.003), while there was no significant difference between the ofloxacin ear drops and VG groups (P = 0.080) or VG and gelfoam patch groups (P = 0.056).The mean hearing gain was 11.4 ± 2.3 dB for the ofloxacin ear drops group, 11.7 ± 4.1 dB for the VG group, and 12.2 ± 1.6 dB for the gelfoam patch group (P = 0.69). ConclusionsThe repairing of traumatic perforations didn't require an exogenous biological scaffold. Ofloxacin ear drops and VG were a deal material for repairing traumatic perforation in otology clinic, which not only was readily available and inexpensive but also showed faster closure compared with dry gelfoam alone.

Effect of collagen on large traumatic perforation of tympanic membrane

&lt;p&gt;Traumatic perforation of the tympanic membrane (TPTM) is often encountered in primary care or in the emergency department (ED). Despite several therapeutic and surgical interventions have been described in the literature, but the conservative approach of follow-up until spontaneous recovery is the most common choice.&lt;sup&gt;1 &lt;/sup&gt;We investigated the utility of bovine collagen extraction patching in the large traumatic TM perforation gives better resultthan spontaneous recovery.&lt;/p&gt;

Clinical Phenotypic Variability and Significance of Pneumolabyrinth After Tympanum-Penetrating Injury.

This study aimed to investigate the clinical manifestations, treatment, and prognosis of traumatic pneumolabyrinth caused by tympanic membrane (TM) perforation. Clinical data were collected from 3 cases of traumatic pneumolabyrinth occurring between 2015 and 2021 and 22 cases were identified from 20 articles in PubMed database that reported pneumolabyrinth due to tympanum-penetrating injury. Nonoperative treatment was performed in Cases 1 and 3. Middle ear inspection was performed 1 year after the injury due to worsening vertigo upon head movement in Case 2. Hearing outcomes and vestibular evaluations were presented for the 3 cases, and all comparable cases in the literature were reviewed. All 25 patients had a history of traumatic TM perforation, with perforations mostly located in the posterior or posterior superior quadrant (16 cases). Air signs were observed in the vestibule in all 25 patients, 15 of whom revealed stapes luxation into the vestibule. Conservative treatments were performed in 8 cases, and exploratory surgery in 17 cases. Most patients were free of vertigo (23/25). There were no significant hearing improvements in 15 cases, while hearing recovery or improvement was observed in 9 cases. The clinical manifestations of pneumolabyrinth due to tympanum-penetrating injuries vary widely. Importantly, the degree of hearing loss is not directly related to the subjectively perceived vertigo but to the location and extent of pneumolabyrinth.

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.