A prospective study evaluating spontaneous healing of aetiology, size and type-different groups of traumatic tympanic membrane perforation.

OBJECTIVES: To evaluate the outcome of spontaneous healing of aetiology-, size- and type-different groups of acute traumatic eardrum perforation and to characterise changes in the morphology of the healing eardrum in various conditions. STUDY
DESIGN: Prospective clinical study.
SETTING: University-affiliated teaching hospital. PARTICIPANTS: A total of 126 patients who visited the Outpatient Department of the Otolaryngology Clinic of Yiwu Central Hospital, Yiwu, China between January 2008 and June 2009 with acute traumatic tympanic membrane perforations. MAIN OUTCOME MEASURES: All participants were allowed to heal spontaneously for 12 months. The clinical outcome including healing rate, healing time, hearing function and air-bone gap recovery as well as morphological changes of the healing tympanic membrane was evaluated on the bases of perforation aetiology, size and type, etc.
RESULTS: By perforation size, the overall healing rate at the end of the 12-month follow-up was comparable to each other in the three (small, medium and large) size groups (P > 0.05); however, there were significant perforation size-dependent differences in the average closure time (P < 0.05). For serosanguinous discharge and dry perforations, the healing rate at the end of 12-month follow-up was similar (95%versus 85%, P > 0.05), but the average healing time was different (16 versus 28 days, P < 0.01) and so was the sequence of granulation tissue formation and epithelial migration in the course of perforation healing. The inverted or everted edges as compared with no curled edges did not significantly affect the healing rate (95%versus 82%, P > 0.05) or closure time (24 versus 27 days). Hearing loss differed significantly between perforations of different causes (P < 0.01), but the perforation cause did not affect recovery of the air-bone defect. Pre-existing tympanosclerosis was the most prominent cause of healing failure.
CONCLUSION: The clinical outcome of spontaneous healing of acute tympanic membrane perforations is generally associated with perforation size, aetiology and whether dry or with a serosanguenous discharge. The sequence of granulation tissue formation and epithelial migration differs during the healing of traumatic tympanic membrane formation in serosanguinous discharge conditions and dry perforation.