Repair of Traumatic Myringorupture

Spontaneous healing of traumatic tympanic membrane perforations in man: A century of experience

“…Kronenberg et al (1988) made the remarkable observation that ears with large and central kidney-shaped perforations show the greatest risk of cholesteatoma formation and that marginal perforations were not a precipitating factor. These findings concur with those of other studies (Amiri, 1977;Sade, 1978) and have been confirmed experimentally (Rogers and Snow, 1968), but are contradicted by investigators claiming that ears with marginal perforations carry the greatest risk of developing cholesteatoma (Oppenheimer et al, 1961;Armstrong, 1972;Silverstein et al, 1973;Kanimturk, 1979;Shambaugh and Glasscock, 1980). This apparent controversy may be based on different pathogenetic mechanisms of cholesteatoma formation following traumatic TM perforation.…”

“…However, Griffin (1979) failed to demonstrate any adverse effects on myringeal healing of ear drops containing corticosteroid. Oppenheimer et al 1961) using submyringeal corticosteroid soaked pledgets of gelfoam to support the TM during healing, observed no failure of closure. Most recently, in an experimental study, surgically performed TM perforations in rats showed a considerably delayed healing pattern when a 2 per cent hydrocortisone suspension was applied once daily for 10 consecutive days (Spandow etal., 1990).…”

“…A great diversity exists regarding the philosophy of treating traumatic TM perforations and associated injuries. Currently, the therapeutic spectrum ranges from expectant observation exclusively (Palmer, 1943;Henry, 1945;Korkis, 1946;Hugh, 1946;Friedman, 1948;Singh and Ahluwalia, 1968;DeWeese and Saunders, 1973;Kerr and Byrne, 1975;Mawson and Ludman, 1979;Lindeman, 1979;Pahor, 1981;Rybak and Johnson, 1983;Kerr and Smyth, 1987) to immediate surgical repair in all cases (Folbre, 1947;Oppenheimer et al, 1961;Armstrong, Accepted for publication: 12 July 1992; Ruggles and Votypka, 1973;Silverstein et al, 1973;Juers, 1974;Sudderth, 1974;Gapanavicius et al, 1977;Merwin and Boies, 1980;Camnitz and Bost, 1985). Although much has been published on the subject since Gruber in 1870, after the Battle of Sadowa in 1866, recorded the first otoscopically visualized, blast-induced perforation of the TM (Craig, 1940) there are still insufficient data available in the literature to guide the otologist in selecting the best treatment procedure (Griffin, 1979;Merwin and Boies, 1980;Camnitz and Bost, 1985;Lindeman etal, 1987;Kristensen et al, 1989).…”

Overlay Versus Underlay Tympanoplasty. Part I: Historical Review of the Literature

“…Keller 145 converted air pressure to sound pressure and estimated that 195 to 199 dB was needed to rupture the drum at 30°C. Oppenheimer et al 146 reported that more sound pressure is needed to rupture the drum at lower frequencies because of its elasticity. In contrast, the tympanic membrane is less resistant at higher frequencies.…”