Traumatic Perforation of the Tympanic Membrane: Etiologies and Risk Factors for Healing and Intervention

Abstract

Objective: To study various etiologies of traumatic tympanic membrane perforation; evaluate the factors involved in healing of traumatic tympanic membrane perforation; and identify patients with perforations unlikely to benefit from conservative management.
 Methods
 Study Design: Prospective observational study
 Setting: Tertiary Government Medical College and Hospital
 Subjects: 64 consecutive cases of traumatic tympanic membrane perforation seen over one year were followed for 3 months. Perforations were assessed in terms of size, etiology, condition of edge and other associated factors or combinations of factors with regards to spontaneous healing, using descriptive statistics and chi-square tests.
 Results: Of the 64 cases, 51 perforations healed while 13 did not. There were significant associations between tympanic membrane condition after 3 months and explosive mode of injury (χ2 = 23.30; p=.00001) as well as with size of perforation ((χ2 = 25.75; p=.00001). The risk of persistence of a tympanic membrane perforation was 34.57 times more among patients with a perforation size >50% compared to those with perforation size ≤50% [OR-34.57 (6.28, 190.14); p= .00001]. Combined, explosive etiology and perforation size >50% were significantly associated with non-healing ((χ2 = 37.60; p = .00001). There were no significant associations with the condition of the edge of the perforation and upper respiratory tract infection.
 Conclusions: An explosive etiology and tympanic membrane perforation size >50% may be significant risk factors predicting non-healing of the perforation. Risk stratification of patients having one or both of these risk factors, with early intervention for those with both, and close monitoring for those with any one of these may lessen unnecessary morbidity. Bigger multicenter future studies are necessary to confirm these initial findings.
 Keywords: tympanic membrane perforation, tympanic membrane, risk factors, wound healing, early intervention

Aftermath of traumatic tympanic membrane perforation: Our findings at a tertiary care hospital in Pakistan

“…p=0.000), that is supported by study of Sannigrahi who found significant association between mode of injury and tympanic membrane perforation after three months (χ2 = 23.30; p = .00001). 13 Another study results also showed that there was statistically significant difference between TM perforation and age of the patient, severity of deafness, size of perforation (p <0.05) as shown. 8 Fazal I Wahid et al…”

“…As slap on the ear was more common resulting perforation at anterio-inferior quadrant of TM on left side hence there was statistically significant association between cause of trauma and site and side of perforation (x=24.13, p=0.020), (x=57.10.p=0.000), that is supported by study of Sannigrahi who found significant association between mode of injury and tympanic membrane perforation after three months (χ2 = 23.30; p = .00001) . 13 Another study results also showed that there was statistically significant difference between TM perforation and age of the patient, severity of deafness, size of perforation (p <0.05) as shown. 8…”

“…7,8,[10][11][12] However etiologic factors of this study differs from that of, Ravi, Dawood, Sannigrahi, and Al-Obiedi where traumatic tympanic perforation was predominantly caused by blast injuries while in one study road traffic accidents was main cause of tympanic membrane perforation. 3,5,13,14 We found that in majority of patients left ear was affected more (58.7%, n-67), and commonest site of perforation of membrane was anterioinferior (43.9% n-50) quadrant. Similarly, Adegbiji and colleagues from Nigeria conducted a study in 2018 and their observations were that left ear was involved more than right (43.9%, 232), grade 1(small size) perforation was most common (39.3%, n-208) and central part of membrane was predominantly affected (38.2%, n-202).…”

“…17 According to available literature spontaneous healing of TTMP occurs in 80 -100% cases. 5,[10][11][12][13][14][15][16]18,19 As slap on the ear was more common resulting perforation at anterio-inferior quadrant of TM on left side hence there was statistically significant association between cause of trauma and site and side of perforation (x=24.13, p=0.020), (x=57.10. p=0.000), that is supported by study of Sannigrahi who found significant association between mode of injury and tympanic membrane perforation after three months (χ2 = 23.30; p = .00001).…”

“… 7 , 8 , 10 - 12 However etiologic factors of this study differs from that of, Ravi, Dawood, Sannigrahi, and Al-Obiedi where traumatic tympanic perforation was predominantly caused by blast injuries while in one study road traffic accidents was main cause of tympanic membrane perforation. 3 , 5 , 13 , 14 …”