Spontaneous closure of traumatic tympanic membrane perforation following long-term observation

Background: Traumatic tympanic membrane perforation (TTMP) is usually managed conservatively because most close spontaneously within a few months. Nevertheless, spontaneous closure of TTMP during long-term observation has not been well described in the literature.

Objectives: The present study investigated factors associated with spontaneous closure of TTMP, and the characteristics of cases exhibiting spontaneous closure following long-term observation.

Materials and Methods: The medical records of 40 patients with TTMP who visited the authors’ hospital were retrospectively reviewed.

Results: Spontaneous closure was observed in 27 (67.5%) patients. The healing period was <2 weeks in 6 cases, <4 weeks in 9, <3 months in 5, <6 months in 3, and ≥6 months in 4. All four cases in which spontaneous closure took ≥6 months exhibited a sign of spontaneous closure at 6 months following injury. Perforation in contact with the malleus was associated with a lower frequency of spontaneous closure.

Conclusions and Significance: In TTMP, surgery should be considered in patients who exhibit perforation in contact with the malleus. However, it has also been suggested that long-term observation may be a viable treatment option when a sign of spontaneous closure is observed within 6 months following injury.     

外伤性鼓膜穿孔的法医学鉴定分析

目的 总结外伤性鼓膜穿孔的法医学鉴定规律。方法 回顾性分析308例316耳外伤性鼓膜穿孔法医学鉴定资料。结果 确诊外伤性鼓膜穿孔237耳，穿孔愈合50耳，穿孔合并感染6耳，排除穿孔11耳，8例（耳）排除与所受外伤的关系，3例（耳）无法认定外伤性鼓膜穿孔，1例（耳）诊为慢性化脓性中耳炎。结论外伤性鼓膜穿孔诊断要点为：（1）有耳部或头部受伤史；（2）伴耳痛、耳聋、外耳道少量出血；（3）形态符合外伤性穿孔特点：穿孔多位于紧张部．呈裂隙状、三角形、不规则形等。穿孔边缘锐利、外翻，附有血痂；（4）声导抗检查不能引出鼓室图，或伤耳呈B型曲线但外耳道容积明显大于健耳；（5）排除中耳炎所致穿孔。声导抗和耳内镜检查可以客观真实的反映鼓膜穿孔的形态特征．能为外伤性鼓膜穿孔的法医学鉴定提供客观依据。     

创伤性鼓膜穿孔的治疗及其研究进展

目的创伤性鼓膜穿孔是耳鼻咽喉科门急诊中常见的疾病之一。对于创伤性鼓膜穿孔的治疗有多种方法可供选择,但是目前国内外尚无统一的标准。创伤性鼓膜穿孔自然愈合机制比较复杂,影响其愈合及预后的因素较多,不合理的治疗会给患者带来不良的影响。本文介绍了创伤性鼓膜穿孔的自然愈合情况,以及汇总近年国内外关于创伤性鼓膜穿孔的治疗及研究进展,并予以综述,旨在为创伤性鼓膜穿孔的临床治疗方法的选择和研究提供参考。     

耳内镜下擦镜纸贴补治疗外伤性鼓膜穿孔

笔者近年来采用耳内镜下擦镜纸贴补治疗外伤性鼓膜穿孔28例,取得良好效果,报告如下。1资料与方法1．1一般资料2008-01—2012—05笔者诊治60例单侧外伤性鼓膜穿孔患者,男11例,女49例;年龄18～36岁,平均（23．44±6．7）岁;病程1～15d,平均（6．2±4．3）d。均无中耳感染。     

特殊类型鼓膜外伤性穿孔急性期外科干预的可行性分析

目的探索特殊类型鼓膜外伤性穿孔急性期外科干预的可行性。方法对本科2001年3月～2006年4月接诊的58例特殊类型鼓膜外伤性穿孔的临床资料及愈合因素进行分析。其中急性期外科干预37例(41耳)同时综合治疗,单纯明胶海绵贴补13例(14耳),保守治疗8例(8耳)。结果外科干预平均愈合时间17.9天,鼓膜愈合率90.24%;单纯贴补24.3天,治愈率57.14%;保守治疗28.1天,治愈率25.00%。结论特殊类型鼓膜外伤性穿孔依据不同类型采用个性化急性期外科干预并综合治疗可明显提高有效治愈率,缩短穿孔愈合时间。     

耳内镜下金因肽棉片贴补治疗外伤性鼓膜穿孔35例

我科于2009-12-2011-03在耳内镜下对35例外伤性鼓膜穿孔患者采用金因肽棉片贴补治疗,疗效满意,报告如下。1资料与方法1.1临床资料35例外伤性鼓膜穿孔患者中,男26例,女9例;年龄14～65岁;病程1～15d。6例并发中耳感     

Spontaneous healing of various tympanic membrane perforations in the rat

Objectives—To investigate the spontaneous healing process of various types of perforation and the location of the epithelial generation center in the tympanic membrane of rats.

Material and methods—Various types of perforation were made in the ears of 50 rats and the healing process was observed using light and electron microscopy.

Results—Epithelia hyperplasia could not be seen at the edge of the perforations, but occurred in the annulus and handle of malleus regions during the early stage of healing. There was no correlation between the healing time and the size of the perforations. When one ear was perforated, no changes were observed in the intact ear on the other side. The epithelium did not migrate into the tympanic cavity in the posterior marginal perforations. All the perforations healed, although the manubria of the malleus were damaged.

Conclusions—The perforations healed by means of epithelial migration. The epithelial generation center was located near the annulus and the handle of the malleus, and therefore protection of these two regions is very important in middle ear surgery.     

External ear resonance in patients with tympanic membrane perforations

This study investigated the effects of a tympanic membrane perforation on the external ear resonance. Measurements of external ear resonance using a probe-tube microphone system were performed in 14 patients who had medium to large unilateral tympanic membrane perforations. The contralateral normal ears of these 14 patients served as control. The results showed that there were no significant differences in the peak frequency, peak amplitude and peak sharpness between perforated and normal ears. However, intersubject variability in the resonant frequency was greater in the perforated group. In addition, the resonance curves of these two groups were substantially different. In 10 out of the 14 patients in the perforated group, the resonance curves showed 2–3 prominent peaks separated by valleys of about 10 dB reduced gain. In addition, in 11 out of 14 perforated ears, reduced responses (3.8 dB in average) occurred consistently in the lower frequency region (0.3–2 kHz). Clinically, the abnormal external ear resonance and the larger intersubject variation must be taken into consideration in fitting hearing aids for this group of patients.     

Effects of mechanical trauma to the human tympanic membrane: an experimental study using transmission electron microscopy

Hypothesis: To examine the cellular events following induced superficial lesions of the human tympanic membrane (TM). Such information could lead to enhanced appreciation of repair mechanisms and novel strategies to restore TM perforations.

Background: Persistent perforation of the TM in chronic otitis media is a major global health problem and frequently necessitates surgical intervention. Most TM perforations heal spontaneously and swiftly, but sometimes healing fails. The underlying mechanisms and the reason for incomplete repair are often elusive, although some mechanisms have been proposed.

Methods: Here, five healthy adult human TMs were sampled during vestibular schwannoma surgery. Three days before harvesting, three TMs were superficially lesioned, including the epithelial and sub-epithelial layers, using a needle and two TMs served as controls. Light and transmission electron microscopy were performed.

Results: Surrounding lesion showed distinct ultrastructural changes. This included a keratinocyte frontier with electron-dense cells with abundant ribosomes and nuclei metamorphosis. Beneath, were activated fibroblasts and invaded/transformed free cells and signs of increased transcellular activity of adjacent blood vessels.

Conclusions: The study describes dynamic morphological events of a human lesioned TM. The human model may be used for further investigations and understanding of TM healing mechanisms.     

内镜下与显微镜下鼓膜大穿孔软骨岛-软骨膜成形术差异分析

目的 对比探讨内镜与显微镜下鼓膜大穿孔软骨岛-软骨膜成形术的异同。方法 慢性化脓性中耳炎静止期大穿孔患者30例,内镜下修补15例,显微镜下修补15例。结果 鼓膜形态：内镜组愈合良好,显微镜组失败3例。听力：内镜组有效10例,显效4例,无效1例;显微镜组有效12例,显效1例,无效2例。结论 鼓膜大穿孔内镜下修补具有损伤小、省时等特点,易于在基层医院开展。     

Errors in the assessment of tympanic membrane perforations

It is commonly stated that operative closure of large perforations of the tympanic membrane is less successful than closure of small perforations. Few authors mention the exact size of the perforations studied, and fewer still give their method of measuring perforations. We describe a photographic method of assessing the size of perforations relative to the total drumhead, measuring them with a computerized digitizing pad. Thirteen temporal bones were selected at random. Perforations of different sizes, shapes and at different sites were fashioned in the tympanic membranes. These were assessed by clinicians of all grades, who were asked to draw the perforations and give estimates of the perforation size as a percentage of the total drumhead. Visual estimates and drawings were compared with a photographic objective method. Gross errors (some in excess of 100%) were apparent in both estimates and drawings. There was a highly significant statistical difference between the objective method and visual estimates and drawings (P < 0.001). Greater clinical experience was not correlated with better performance in estimating the size of perforations.     

"聪耳药膜"治疗鼓膜穿孔的疗效及愈合过程的超微结构的观察

目的 探讨“聪耳药膜”治疗鼓膜穿孔的疗效及其作用机制。方法 98例（102耳）鼓膜穿孔患者，按1：1随机分为实验组48例（52耳）以中药制剂“聪耳药膜”补贴鼓膜穿孔；和对照组50例（50耳）以棉片补贴鼓膜穿孔。对比观察鼓膜穿孔愈合情况。另以20只健康成年豚鼠，随机分为两组制作鼓膜穿孔，对照组不作补贴，中药膜组用中药膜补贴穿孔。结果 聪耳药膜实验组的痊愈率为21．2％，总有效率为88．5％；对照组的痊愈率为8．0％，总有效率为54．0％，（P〈0．05）。两组疗效差异有显著性意义。豚鼠鼓膜穿孔造模术后1月、2月透射电镜观察，聪耳药膜组及造模对照组的穿孔均已愈合。但中药膜组的组织修复形态较对照组为优。结论 聪耳药膜治疗鼓膜穿孔有满意的临床疗效，为安全有效的中药制剂。     

重组人表皮生长因子在外伤性鼓膜穿孔治疗中的临床应用

外伤性鼓膜穿孔是耳鼻咽喉科的常见病、多发病,近年来有上升趋势。鼓膜穿孔破坏了鼓膜的正常结构并影响鼓膜的正常生理功能,穿孔后鼓室与外耳道直接相通,为病原微生物侵入中耳打开了门户,且鼓膜穿孔患者常有不同程度的耳闷、耳鸣及听力下降等症状,对患者的生理及心理造成一定影     

Chronic tympanic membrane perforation in an animal model

Objective

The aim of this study was to revalidate and reproduce a chronic tympanic membrane perforation animal model.

Study design

Prospective, animal study.

Methods

Eight female chinchillas underwent bilateral thermal myringotomy. The edges of the perforation were folded inward using microflaps. The perforations were followed over time to monitor the course of closure.

Results

Two animals were excluded from the study because of ear infection. None of the other tympanic membrane perforations remained open. The closing time varied from 4 to 6 weeks.

Conclusions

Our findings demonstrate that the thermal myringotomy combined with infolding technique is not a reliable and consistent method to create a chronic tympanic membrane perforation. The closing time is shorter than expected and varies among the study subjects.There is a clear need for developing a reliable chronic tympanic membrane perforation model.     

He-Ne激光、高流量吸氧及牛血去蛋白治疗外伤性鼓膜穿孔

目的评价He-Ne激光、高流量吸氧配合药物治疗外伤性鼓膜穿孔的疗效。方法 将外伤性鼓膜穿孔患者112例随机分为治疗组（42例43耳）、对照Ａ组（40例40耳）、对照Ｂ组（30例30耳）。治疗组应用He-Ne激光局部照射、配合药物治疗同时高流量吸氧;对照Ａ组自然恢复、对照Ｂ组采用鼓膜贴补治疗。于治疗2、4周后分别观察鼓膜穿孔的愈合情况。随访3个月。结果治疗组治疗2、4周后治愈率分别为71.43%、95.24%,明显高于对照Ａ组（P＜0.01）,与对照Ｂ组比较,差异无统计学意义。结论He-Ne激光、高流量吸氧配合药物治疗外伤性鼓膜穿孔疗效良好,鼓膜愈合时间缩短,治愈率高。     

声导抗测试结合鼓膜摄像在外伤性鼓膜穿孔诊断中的应用

目的 探讨声导抗检测结合鼓膜摄像在外伤性鼓膜穿孔诊断中的应用价值。方法 回顾性分析南京市第二医院门诊2019年4月—2020年4月接诊的37例(共44耳)外伤性鼓膜穿孔患者的临床资料。接诊时详细询问患者病史,采用声导抗检测和/或鼓膜摄像检查。按照检测方法分鼓膜摄像组与联合组(声导抗检测联合鼓膜摄像),对比两种检查方法在外伤性鼓膜穿孔诊断中的灵敏度、特异度及准确度。结果 鼓膜摄像组在检测外伤性鼓膜穿孔诊断中的灵敏度为91.12%、特异度为50.00%、准确度为81.82%;联合组在检测外伤性鼓膜穿孔诊断中的灵敏度为100%、特异度为100%、准确度为100%,两组检测方法相比,联合组均高于鼓膜摄像组,差异均具有统计学意义(P<0.05)。结论 单纯凭借鼓膜摄像容易发生漏诊误诊,声导抗检测结合鼓膜摄像用于诊断外伤性鼓膜穿孔,其灵敏度、特异度及准确度更高。