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

Abstract

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.

Observational Study of Traumatic Tympanic Membrane Perforations in Relation to Aetiology and Management

“…Temporal bone houses many vital structures, involvement of these structures in temporal bone fractures is possible in road traffic accident including blunt trauma, laceration, avulsion of the part or whole of the pinna with tympanic membrane perforation. [12][13][14][15][16][17] CONCLUSION: Overall healing in all the patients with traumatic perforations with either conservatively (90%) spontaneous healing or with myringoplasty (10%) groups were 100%. It is very common in day-to-day life and the highest incidence is by slap and Road Traffic Accident, that too in males age group between 20-30 years of age.…”

Impact of the nature of the temporalis fascia graft on the outcome of type I underlay tympanoplasty

“…A dry graft may become wet after insertion into the middle ear if bleeding develops at the perforation edges and in the middle-ear mucus. During spontaneous healing of traumatic tympanic membrane perforations with eardrum bridges, Lou found that a few bridges gradually became necrotic and merged into the newly healed eardrums 32 . In addition, when a dry graft is placed in the wet physiological environment of the middle ear, it will shrink and lose contact with the remnant margins of the tympanic membrane under which it is tucked, especially anteriorly, and cause graft failure 33 …”