Abstract
Objective
The goal of this study was to evaluate the effects of crust formation on the healing of traumatic, dry, and minor-sized tympanic membrane perforations (TMPs) in humans.
Study design
Case series with a chart review.
Setting
Tertiary university hospital.
Materials and methods
The clinical records of patients with traumatic TMPs who met the case selection criteria were retrieved and categorized according to the presence of a crust and the timing of crust formation into three groups: no crust, early crust formation, and late crust formation. Healing outcomes (i.e., healing rate and time) in the three groups were analyzed.
Results
In total, 83 patients were analyzed. The perforation closure rates were 92%, 100%, and 78% in the groups with no-crust, early crust formation, and late crust formation, respectively. No significant difference was seen between the groups with no-crust and with late crust formation ( p > 0.05). By contrast, closure rates differed significantly between the early and late crust formation groups ( p < 0.05). Overall, the no-crust and early crust formation groups showed shorter healing times compared with the late crust formation group ( p < 0.05). However, closure times did not differ significantly between groups with early crust formation and no crust ( p > 0.05).
Conclusions
Crust formation at the margin of a traumatic TMP may serve as a predictor of healing outcome. Compared with perforations with early crust formation or no crust, late crust formation can result in delayed healing and failure to close completely.
1
Introduction
Epithelial migration on the tympanic membrane (TM) and external auditory canal (EAC) has been observed in humans and other animals . Epithelial migration is necessary to remove debris such as keratin and foreign bodies from the TM because a crust or foreign matter on the TM may disturb the pattern of TM vibration. Similarly, any crust that forms during the healing process of traumatic TM perforations (TMPs) must move from the healing eardrum to the EAC via epithelial migration. Previous studies of TM epithelial migration have focused on migration rates and patterns; to the best of our knowledge, no study has investigated how crust formation affects eardrum healing. Therefore, we investigated two main research questions: What kind of crust formed, if any, and did crust formation affect eardrum healing?
In this study, we used an endoscope to observe the formation of crusts during the healing process of traumatic TMPs in humans; we also compared how the presence or lack of crust formation affected the closure of traumatic TMPs.
2
Methods
2.1
Ethical considerations
The study protocol, including access to and use of medical records, was approved by the Institutional Ethics Committee of Wenzhou Medical College-Affiliated Yiwu Hospital.
2.2
Case selection
The clinical records of patients with traumatic TMPs who presented to the Otolaryngology Outpatient Clinic of Wenzhou Medical College-Affiliated Yiwu Hospital in China between September 2010 and September 2011 were accessed through the Records Department of the hospital. Cases that met the following inclusion criteria were retrieved for analysis: (1) patients with acute traumatic eardrum perforation resulting from a blow to the head, fresh perforation (within 3 days of injury), perforation size < 1/4 eardrum size, and dry perforation; (2) a conservative management approach was adopted, and no secondary infection arose during the healing process; and (3) otoendoscopic video images of the spontaneous healing process were recorded twice weekly until closure of the perforation or the end of a 6-month follow-up period.
Cases with inadequate documentation of otologic examination findings and cases with secondary infection after the ear injury were excluded.
2.3
Data analyses
All clinical records and otoendoscopic videos of patients were made available by the Records Department of the hospital. All recorded video images were imported into a computer for storage. Then, the size of the perforation, the timing of crust formation at the perforation edge, and the ultimate healing outcome were estimated by an independent, blinded reviewer using ImageJ software (AutoCAD R14). The patients were divided into three groups depending on the presence of a crust and the timing of crust formation shown on the video images: no crust, early crust formation (within 1 week of injury), and late crust formation (> 1 week after injury).
The demographic characteristics of the patients, including age, sex, and number of days between injury and hospital visit, were analyzed as categorical data using the chi-squared test. The primary outcome measures assessed were the extent of healing at the end of the 6-month follow-up period and average healing time. These outcome data were compared using a two-sample t -test. All tests were performed using SPSS software (SPSS Inc., Chicago, IL, USA). Differences were considered statistically significant when p < 0.05.
2
Methods
2.1
Ethical considerations
The study protocol, including access to and use of medical records, was approved by the Institutional Ethics Committee of Wenzhou Medical College-Affiliated Yiwu Hospital.
2.2
Case selection
The clinical records of patients with traumatic TMPs who presented to the Otolaryngology Outpatient Clinic of Wenzhou Medical College-Affiliated Yiwu Hospital in China between September 2010 and September 2011 were accessed through the Records Department of the hospital. Cases that met the following inclusion criteria were retrieved for analysis: (1) patients with acute traumatic eardrum perforation resulting from a blow to the head, fresh perforation (within 3 days of injury), perforation size < 1/4 eardrum size, and dry perforation; (2) a conservative management approach was adopted, and no secondary infection arose during the healing process; and (3) otoendoscopic video images of the spontaneous healing process were recorded twice weekly until closure of the perforation or the end of a 6-month follow-up period.
Cases with inadequate documentation of otologic examination findings and cases with secondary infection after the ear injury were excluded.
2.3
Data analyses
All clinical records and otoendoscopic videos of patients were made available by the Records Department of the hospital. All recorded video images were imported into a computer for storage. Then, the size of the perforation, the timing of crust formation at the perforation edge, and the ultimate healing outcome were estimated by an independent, blinded reviewer using ImageJ software (AutoCAD R14). The patients were divided into three groups depending on the presence of a crust and the timing of crust formation shown on the video images: no crust, early crust formation (within 1 week of injury), and late crust formation (> 1 week after injury).
The demographic characteristics of the patients, including age, sex, and number of days between injury and hospital visit, were analyzed as categorical data using the chi-squared test. The primary outcome measures assessed were the extent of healing at the end of the 6-month follow-up period and average healing time. These outcome data were compared using a two-sample t -test. All tests were performed using SPSS software (SPSS Inc., Chicago, IL, USA). Differences were considered statistically significant when p < 0.05.
3
Results
3.1
Demographic data
The study recruited 143 consecutive patients who suffered injuries or blows to the ear resulting in acute TM perforations: 60 patients were excluded based on appropriate criteria. Ultimately, 83 cases (34 males, 49 females) who met the inclusion criteria were analyzed.
The patients were divided into three groups depending on the presence of a crust and the timing of crust formation: no crust (24 patients, 29%), early crust formation (within 1 week of injury; 32 patients, 39%), and late crust formation (> 1 week after injury; 27 patients, 32%). Mean ages in the three groups were 30.1 ± 1.1, 29.4 ± 2.1, and 29.8 ± 1.6 years, respectively. The mean intervals between injury and hospital visit were 2.3 ± 0.8, 3.1 ± 1.9, and 2.7 ± 1.2 days, respectively. The average age, male-to-female patient ratio, and average time elapsed between injury and hospital visit were similar in the three groups ( p > 0.05).
3.2
Perforation location and pre-existing pathology
Table 1 presents the locations of perforations and pre-existing myringosclerosis in the three groups. No significant difference in pre-existing myringosclerosis was observed between the no-crust and late crust formation groups ( p > 0.05), but a significant difference was found between the early and late crust formation groups ( p < 0.05). Perforation locations were similar in all three groups ( p > 0.05).
