Determinants of spontaneous healing in traumatic perforations of the tympanic membrane

Orji, Foster Tochukwu; Agu, Chidozie

doi:10.1111/j.1749-4486.2008.01764.x

Cited by 122 publications

(106 citation statements)

References 14 publications

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“…A shared histological feature of both structures is their lack of vascular supply implying that in any event of injury the process of healing cannot follow traditional mechanisms of repair (13). Although not specifically tested, it then becomes more natural for fetal membranes to follow the repair sequence of other avascular human tissues such as cornea and tympanic membrane where the key event is the migration of the epithelium adjacent to the site of injury across the defect (14)(15)(16).…”

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confidence: 99%

Histologic changes of the fetal membranes after fetoscopic laser surgery for twin-twin transfusion syndrome

et al. 2015

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Background: Preterm premature rupture of membranes remains a major complication after fetoscopic laser surgery (FLS) for twin-twin transfusion syndrome (TTTS). We studied the histologic changes of fetal membranes post-FLS and investigated a possible impact of amniotic fluid (AF) dilution. Methods: Fetal membranes of 31 pregnancies that underwent FLS for TTTS were investigated histologically at delivery at different sites: trocar site of recipient sac and at distance, donor sac, and inter-twin membrane. results: The trocar insertion site on the recipient sac showed no signs of histologic hallmarks of healing. Wide-spread alteration in collagen organization and higher apoptotic index in the amnion of the recipient sac which were absent in donor's and reference membranes. To explain the mechanisms, we analyzed the AF composition of recipient sacs from TTTS pregnancies vs. GA-matched healthy singleton controls and found glucose, protein and lactate dehydrogenase activity were all significantly lower in TTTS sacs consistent with over-dilution of recipient's AF (~2-fold). In-vitro exposure of healthy amniochorion to analogous dilutional stress conditions recapitulated the histologic changes and induced apoptosis and autophagy. conclusion: Alteration in structural integrity of the recipient's amniochorion, possibly in response to dilution stress, along with ineffective repair mechanisms may explain the increased incidence of preterm birth post-FLS.d espite the success of fetoscopic laser surgery (FLS) for the treatment of severe twin-twin transfusion (TTTS), preterm delivery with or without preterm premature rupture of membranes (PPROM) remains a major complication (1-4). The average gestational age at delivery after procedure ranges between 29 to 33 wk (1,5). Aside from the cost of caring for the premature infants, preterm delivery is directly associated with long-term neurological deficits in TTTS (4,6), undermining the complete benefits of such intervention. PPROM which affects 20-32% of cases is the most important risk factor leading to preterm delivery (2,7-10).Considered a minimally invasive procedure, FLS necessitates the insertion of a trocar into the amniotic cavity of the recipient twin to allow for insertion of the fetoscope (through a cannula which stays in place throughout the procedure) (11). A laser is used to seal the abnormal blood vessel anastomoses between the monochorionic twin placentas. Lastly, the surgeon performs an amnioreduction to relieve the recipient's polyhydramnios by draining the excess amniotic fluid (AF) through the cannula before removing it. During the procedure to allow proper visualization due to the inadvertent loss of amniotic fluid through cannula port or due to cloudy AF, it is customary for the surgeon to remove a volume of AF and replace it via amnioinfusion with a solution of Lactated Ringer's (LR).Fetal membranes are the outermost layer of fetal compartment in apposition to maternal decidua. The amniotic layer of the fetal membranes is made up of a lining of cuboidal epithe...

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confidence: 99%

Histologic changes of the fetal membranes after fetoscopic laser surgery for twin-twin transfusion syndrome

et al. 2015

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“…With multivariate analysis, we found that perforation size was the single determining factor related to closure time, a finding also reported in some other studies. 2,4 In addition, some authors have stressed the negative influence of ear discharge and increasing age on closure time. 3,4 We found no obvious importance of perforation location, a finding supported by others.…”

Section: Discussionmentioning

confidence: 99%

“…2,4 In addition, some authors have stressed the negative influence of ear discharge and increasing age on closure time. 3,4 We found no obvious importance of perforation location, a finding supported by others. 4 Previous reports of the importance of inverted and everted edges are contradictory, 3,5 but it has been stated that the type of epithelial migration has importance for closure time but not for closure rate.…”

Section: Discussionmentioning

confidence: 99%

“…1 Subsequent studies showed similar findings, with spontaneous closure rates ranging from 80 to 97 per cent. [2][3][4][5] For cases of large perforations and blast injuries, spontaneous closure rates have been observed to range from 56 to 82 per cent. 6,7 Studies comparing outcomes after observation only versus different active surgical interventions using various techniques have shown spontaneous closure rates between 53 and 86 per cent in the observation only groups, 8 and closure rates between 88 and 100 per cent in the operated groups.…”

Section: Introductionmentioning

confidence: 99%

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Spontaneous closure of traumatic tympanic membrane perforations: observational study

2015

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Background: The treatment of traumatic tympanic membrane perforations varies in different investigations, ranging from observation to early surgical repair. The present study aimed to focus on the closure rate and the closure time in a group of patients treated with a watchful waiting policy.Methods: The study comprised 133 consecutive patients with a total of 137 perforations. Data were evaluated in terms of aetiology, location and size of perforation, audiometric findings, closure rate, and closure time.Results: The overall closure rate was 97 per cent. For patients with a known closure time within three months, the median closure time was between three and four weeks. The probability of spontaneous closure over time was further analysed with Kaplan-Meier plots, for those perforations with known closure times and for all perforations including those with unknown closure times. Perforation size was the only significant determining factor for closure time.Conclusion: Small perforations had a high probability of spontaneous closure within three to four weeks, justifying a watchful waiting policy. Larger uncomplicated perforations might warrant early surgical repair, depending on the patient's needs and the availability of surgery.

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“…[1][2] The rate of spontaneous healing ranges between 48-94%. [6][7][8][9][10][11] Griffen reported 90% spontaneous healing of TM perforation within 3 months of injury. 12 Kristensen reported 78.7 % spontaneous healing within 2 weeks of injury whereas Chun et al reported 76% of complete spontaneous healing within 3 weeks.…”

Section: Discussionmentioning

confidence: 99%

Role of nasal decongestants in spontaneous healing of traumatic tympanic membrane perforation

Rai

Koirala

Sharma

2017

Nepalese J ENT Head Neck Surg

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Objective: To study the role of nasal decongestants in spontaneous healing of traumatic tympanic membrane perforation.Material and Methods: A prospective single blinded, randomized controlled study was carried out in the department of ENT, Manipal College of Medical Sciences, Pokhara, Nepal. Patients with traumatic tympanic membrane perforation were divided into two groups; those receiving nasal decongestants along with conservative measures (Group1) and those receiving conservative measures only (Group2). Healing of tympanic membrane was compared in between these groups at 1 and 3 months. Statistical analysis was done using SPSS 20.Results: There were 30 patients in group 1 and 28 patients in group 2. The mean age of the study population was 26.98 (SD= 7.53). The M: F ratio in group 1 was 0.58:1 and that in group 2 was 0.56:1. Complete healing was seen in 25 (83%) patients in group 1 and 16 (57.1%) patients in group 2 at the end of 1 month (P=0.029). Similarly, healing was seen in in 29 (96.7%) patients in group 1 and 21 (75%) patients in group 2 at the end of 3 months (P=0.023).Conclusion: Routine use of nasal decongestants increases the chances of spontaneous healing of traumatic tympanic membrane perforations.

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Determinants of spontaneous healing in traumatic perforations of the tympanic membrane

Cited by 122 publications

References 14 publications

Histologic changes of the fetal membranes after fetoscopic laser surgery for twin-twin transfusion syndrome

Histologic changes of the fetal membranes after fetoscopic laser surgery for twin-twin transfusion syndrome

Spontaneous closure of traumatic tympanic membrane perforations: observational study

Role of nasal decongestants in spontaneous healing of traumatic tympanic membrane perforation

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