Abstract
Objective
This study investigated the influence of the degree of bleeding from the remnant eardrum on the spontaneous healing of human traumatic tympanic membrane perforations (TMPs).
Study design
A case series with chart review.
Setting
A tertiary university hospital.
Materials and methods
The clinical records of traumatic TMP patients who met the case selection criteria were retrieved and categorized into two groups based on the documented degree of bleeding from the remnant eardrum: with and without bleeding. The demographic data and spontaneous healing outcomes (i.e., healing rate and duration) of these two TMP types were analyzed using the chi-squared test or t -test.
Results
One-hundred and eighty-eight cases met the inclusion criteria and were analyzed. Of these, 58.5% had perforations without bleeding and the remaining 41.5% had perforations with bleeding. The overall closure rate at the end of the 3-month follow-up period was 90.9% for perforations without bleeding and 96.2% for perforations with bleeding; the difference was not statistically significant (P > 0.05). However, the average closure time differed significantly between the two groups (P < 0.05): 29.4 ± 3.7 days for perforations without bleeding and 20.6 ± 9.2 days for perforations with bleeding. The closure rate was significantly different between the groups (62 vs. 15.6%, P < 0.01) within 2 weeks for medium-sized perforations. In total, 11 (39.3%) large-sized perforations achieved complete closure in the group with bleeding, while none of the large-sized perforations closed in the group without bleeding within 2 weeks. The closure rate of medium-sized perforations was not significantly different (79.2 vs. 92%, P > 0.05) between the groups without and with bleeding within 4 weeks, while the closure rate of large-sized perforations was significantly different between the groups without and with bleeding (27.2 vs. 75%, P = 0.0).
Conclusion
This study shows that traumatic TMPs with bleeding significantly shortened the closure time compared to TMPs without bleeding. This finding indicates a significant correlation between the prognosis of traumatic TMPs and the degree of eardrum bleeding: severe bleeding from and a hematoma in the remnant eardrum appear to be good signs.
1
Introduction
Traumatic tympanic membrane perforation (TMP) is a common entity. While most traumatic TMPs tend to heal spontaneously, some fail to heal and can result in conductive hearing loss, tinnitus, and repeated infections of the middle ear. Factors that can influence the spontaneous healing of traumatic TMPs include age, sex, ear size, TMP size, perforation position, cause, an inverted edge, and malleus and umbo injury . Of these, a large perforation, tympanosclerosis, and malleus and umbo injury have been found to correlate significantly with a failure to heal and prolonged healing . In addition, TMPs are usually accompanied by tympanic membrane bleeding . However, the correlation between the degree of bleeding from the tympanic membrane and the prognosis of spontaneous healing has been under-reported in the literature. Thus, this study evaluated the influence of the degree of bleeding from the tympanic membrane on spontaneous healing outcomes.
2
Materials and methods
2.1
Ethical considerations
The study protocol, including the access to and use of medical records, was approved by the Institutional Ethics Committee of Yiwu Center Hospital and The affiliated Yiwu hospital of Wenzhou Medical University.
2.2
Case selection
The clinical records of traumatic TMP patients who presented to the Otolaryngology Outpatient Clinic at Yiwu Center Hospital and The affiliated Yiwu Hospital of Wenzhou Medical University, China, between January 2010 and December 2015 were accessed through the Records Department of the Hospital. Cases that met the following inclusion criteria were retrieved for analysis: (1) patients older than 14 years with acute TMP following barotrauma (e.g., an explosive blast injury or a slap or blow to the ear); (2) perforation within 15 days of the injury; (3) adoption of a conservative management approach, with no secondary infections arising during the healing process; (4) recorded otoendoscopy video images of the spontaneous healing process taken once a week until perforation closure or during the 3-month follow-up period; and (5) a minimum perforation size of one-eighth of the pars tensa at the initial visit. Cases with inadequate documentation of otologic examination findings, a history of middle ear disease, or secondary infection after ear injury were excluded. Cases resulting from a penetrating injury through the external auditory canal (EAC) were also excluded. The perforation size was graded as follows: medium (1/8–1/4) and large (> 1/4) .
2.3
Data analysis
All clinical records and otoendoscopic videos of the patients were made available by the Records Department of the Hospital. All recorded video images were imported into a computer for storage. Next, the size and position of each perforation, the degree of bleeding, and the ultimate healing outcome were estimated by an independent, blinded reviewer using ImageJ software (AutoCAD R14). The perforation was categorized as either without bleeding or with bleeding based on the degree of bleeding from the remnant eardrum and perforation edge on the first visit and the healing process as shown on the video images. The perforation position was categorized as the anterior half of the tympanic membrane, the posterior half of the tympanic membrane, or a central shape based on the malleus.
A perforation without bleeding was defined as no bleeding or hematoma observed on the perforation edge and remnant eardrum, or only a small amount of bleeding seen on the perforation edge, the bleeding area being less than one-fifth of the remnant eardrum ( Fig. 1 A ). A perforation with bleeding was defined as bleeding and a hematoma visible on the perforation edge, remnant eardrum, and tympanic cavity, the bleeding area being more than two-fifths of the remnant eardrum ( Fig. 1 B). The demographic characteristics of the patients, including age, sex, and number of days between the injury and hospital visit, were analyzed as categorical data with the chi-squared test. The primary outcome measures assessed were the extent of healing at the end of the 3-month follow-up period and the average healing time. These outcome data were analyzed using a two-sample comparison t -test. All tests were performed using SPSS software (SPSS Inc., Chicago, IL, USA). Differences were considered statistically significant at P < 0.05.
2.4
Technical method
All patients were allowed to heal spontaneously. Oral amoxicillin was administered for 1 week to prevent infections. Follow-up was scheduled once a week until complete closure of the perforation, or up to 3 months. The patient was advised not to wet the ears and to antedate their appointments if discharge appeared.
2
Materials and methods
2.1
Ethical considerations
The study protocol, including the access to and use of medical records, was approved by the Institutional Ethics Committee of Yiwu Center Hospital and The affiliated Yiwu hospital of Wenzhou Medical University.
2.2
Case selection
The clinical records of traumatic TMP patients who presented to the Otolaryngology Outpatient Clinic at Yiwu Center Hospital and The affiliated Yiwu Hospital of Wenzhou Medical University, China, between January 2010 and December 2015 were accessed through the Records Department of the Hospital. Cases that met the following inclusion criteria were retrieved for analysis: (1) patients older than 14 years with acute TMP following barotrauma (e.g., an explosive blast injury or a slap or blow to the ear); (2) perforation within 15 days of the injury; (3) adoption of a conservative management approach, with no secondary infections arising during the healing process; (4) recorded otoendoscopy video images of the spontaneous healing process taken once a week until perforation closure or during the 3-month follow-up period; and (5) a minimum perforation size of one-eighth of the pars tensa at the initial visit. Cases with inadequate documentation of otologic examination findings, a history of middle ear disease, or secondary infection after ear injury were excluded. Cases resulting from a penetrating injury through the external auditory canal (EAC) were also excluded. The perforation size was graded as follows: medium (1/8–1/4) and large (> 1/4) .
2.3
Data analysis
All clinical records and otoendoscopic videos of the patients were made available by the Records Department of the Hospital. All recorded video images were imported into a computer for storage. Next, the size and position of each perforation, the degree of bleeding, and the ultimate healing outcome were estimated by an independent, blinded reviewer using ImageJ software (AutoCAD R14). The perforation was categorized as either without bleeding or with bleeding based on the degree of bleeding from the remnant eardrum and perforation edge on the first visit and the healing process as shown on the video images. The perforation position was categorized as the anterior half of the tympanic membrane, the posterior half of the tympanic membrane, or a central shape based on the malleus.
A perforation without bleeding was defined as no bleeding or hematoma observed on the perforation edge and remnant eardrum, or only a small amount of bleeding seen on the perforation edge, the bleeding area being less than one-fifth of the remnant eardrum ( Fig. 1 A ). A perforation with bleeding was defined as bleeding and a hematoma visible on the perforation edge, remnant eardrum, and tympanic cavity, the bleeding area being more than two-fifths of the remnant eardrum ( Fig. 1 B). The demographic characteristics of the patients, including age, sex, and number of days between the injury and hospital visit, were analyzed as categorical data with the chi-squared test. The primary outcome measures assessed were the extent of healing at the end of the 3-month follow-up period and the average healing time. These outcome data were analyzed using a two-sample comparison t -test. All tests were performed using SPSS software (SPSS Inc., Chicago, IL, USA). Differences were considered statistically significant at P < 0.05.
2.4
Technical method
All patients were allowed to heal spontaneously. Oral amoxicillin was administered for 1 week to prevent infections. Follow-up was scheduled once a week until complete closure of the perforation, or up to 3 months. The patient was advised not to wet the ears and to antedate their appointments if discharge appeared.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
