Early repair of traumatic perforations of the tympanic membrane in children

Winerman, I.; Man, A.; Segal, Shmuel

doi:10.1016/0165-5876(82)90074-x

Cited by 19 publications

(16 citation statements)

References 9 publications

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“…It is believed that curled TMP edges may result in abnormal epithelial migration and closure failure . Benefits of approximation of curled perforation edges in reducing the perforation size and facilitating healing have been reported previously . In this study, curled edge approximation alone neither speeded up the closure nor improved the overall healing rate in cases of large perforations as compared to spontaneous healing.…”

Section: Discussionmentioning

confidence: 54%

“…8,15 Benefits of approximation of curled perforation edges in reducing the perforation size and facilitating healing have been reported previously. 8,[11][12][13][14] In this study, curled edge approximation alone neither speeded up the closure nor improved the overall healing rate in cases of large perforations as compared to spontaneous healing. Otoscopic examinations showed that the approximated curled edges on the side of the malleus handle returned to their original positions.…”

Section: Comparisons With Other Studiesmentioning

confidence: 96%

“…In addition, most large traumatic TMPs have curled edges, and the necessity to manipulate curled edges is also controversial. Some authors believe that curled edges may result in abnormal epithelium migration and failure of closure; in particular, inverted edges could migrate into the tympanum and develop middle ear cholesteatoma; ideal management should be to restore the original position …”

mentioning

confidence: 99%

“…Some authors believe that curled edges may result in abnormal epithelium migration and failure of closure; in particular, inverted edges could migrate into the tympanum and develop middle ear cholesteatoma; ideal management should be to restore the original position. [11][12][13][14] In one of our recent publications, 3 we compared edge approximation plus gelfoam patch, gelfoam patch and spontaneous healing on the outcome of traumatic TMPs with inverted or everted edges. The results showed that gelfoam patch plus edge approximation only shortened the healing time, but did not improve the healing rate.…”

mentioning

confidence: 99%

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Healing outcomes of large (>50%) traumatic membrane perforations with inverted edges following no intervention, edge approximation and fibroblast growth factor application; a sequential allocation, three‐armed trial

Lou

Wang

2013

Clinical Otolaryngology

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ObjectiveThe goal of this study was to evaluate the effects of perforation edge approximation and direct application of basic fibroblast growth factor (bFGF) each alone on the healing of large traumatic tympanic membrane perforations with inverted edges in humans.Study DesignProspective, sequential allocation, three-armed, controlled clinical study.SettingUniversity-affiliated teaching hospital.ParticipantsFifty-eight patients with large traumatic tympanic membrane perforations (i.e. affecting >50% of the surface area) with inverted edges were recruited. They were sequentially allocated to three groups: no intervention (n & 18), edge approximation alone (n & 20) and direct application of bFGF (n & 20). Otoscopy were performed before the treatment and at follow-up visits.Main outcome measuresThe closure rate, closure time and rate of otorrhoea.ResultsApplication of bFGF yielded a significantly higher average rate of perforation closure (100%) than edge approximation (60%) and no intervention (56%) (P < 0.05). It also significantly shortened the average closure time (12.4 ± 3.6 days) as compared to edge approximation (46.3 ± 8.7 days) and no intervention control (48.2 ± 5.3 days) (P < 0.05). Purulent otorrhoea was observed in none of the three groups.ConclusionEdge approximation of inverted edges has little benefit in improving the healing outcome of large traumatic tympanic membrane perforations and thus is not an ideal treatment option for large traumatic tympanic membrane perforations. Application of bFGF materially improves the closure rate of large traumatic tympanic membrane perforations and significantly shortens the closure time.

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Section: Discussionmentioning

confidence: 54%

Section: Comparisons With Other Studiesmentioning

confidence: 96%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Healing outcomes of large (>50%) traumatic membrane perforations with inverted edges following no intervention, edge approximation and fibroblast growth factor application; a sequential allocation, three‐armed trial

Lou

Wang

2013

Clinical Otolaryngology

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“…Management strategies for traumatic conductive hearing loss (CHL) are not as clear. Reports include immediate exploration and repair within days of traumatic injury (3,4), exploration and repair after 6 to 7 weeks for suspected traumatic ossicular lesions (5), or exploration and repair after 3 months (1,6,7). This variability may be due to the lack of data demonstrating the natural history of traumatic CHL.…”

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confidence: 99%

Outcomes for Conservative Management of Traumatic Conductive Hearing Loss

Grant

Arganbright

Friedland

2008

Otology &Amp; Neurotology

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

Lou

2013

Eur Arch Otorhinolaryngol

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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.

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Early repair of traumatic perforations of the tympanic membrane in children

Cited by 19 publications

References 9 publications

Healing outcomes of large (>50%) traumatic membrane perforations with inverted edges following no intervention, edge approximation and fibroblast growth factor application; a sequential allocation, three‐armed trial

Healing outcomes of large (>50%) traumatic membrane perforations with inverted edges following no intervention, edge approximation and fibroblast growth factor application; a sequential allocation, three‐armed trial

Outcomes for Conservative Management of Traumatic Conductive Hearing Loss

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

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