Traumatic Tympanic Membrane Perforation in Tertiary Health Institution

Abstract

Background: Traumatic tympanic membrane perforation is a common otologic disorder with associated hearing impairment. Objective: This study aimed at determining the clinico-epidemiological pattern, etiological factors, clinical presentation and management of traumatic tympanic membrane perforation in a Tertiary institution in Nigeria. Materials and Methods: This was a prospective hospital based study of patients with history of traumatic perforated of tympanic membrane. The study was carried out over a period of 5 years (September 2012 to August 2017). A study proforma was used to obtain detailed history and clinical findings from consenting patients. Data collected were collated and analyzed using SPSS version 16.0. Results: Prevalence of traumatic tympanic membrane perforation in this study was 2.1%. There were 65.5% males and 34.5% females with a male to female ratio of 2:1. The common presenting symptoms among the patients were hearing impairment in 68.3%, otalgia in 62.7% and tinnitus in 61.3%. Slap on the ear was the commonest cause of traumatic tympanic membrane perforation in 43.7% of the patients followed by self-ear cleaning in 16.9%. Commonest causes of slap in this study were 15.5% from security agent, 12.7% from seniors/boss while 9.9 % are from spouses. Unilateral traumatic perforation was more common in 97.9% than bilateral in 2.1%. The left ear traumatic perforation was more common than right ear tympanic perforation as 53.5% and 44.4% respectively. Grade 2 in 39.4% was the commonest perforation. Majority of the traumatic perforation were 40.8% central and 33.8% anterior central. Commonest comorbid injuries were subconjunctival hemorrhage in 16.2% and fracture temporal bone in 13.8%. Conductive hearing impairment in 69.7% and sensorineural hearing impairment in 17.6% were the commonest type of hearing impairment in our patients. Commonest degrees of hearing impairment were mild and moderate which accounted for 47.9% and 26.8% respectively. Commonest complications of traumatic tympanic membrane perforation were 68.3% hearing impairment and 26.1% tinnitus. Majority (73.9%) of the patients had conservative/medical therapy and 74.6% traumatic perforation healed at the end of 3 months. Conclusion: Traumatic perforation arises mainly from direct injuries in this study. The patients tend to present with hearing loss and unilateral involvement is the most common. There is the need to educate the public on the dangers of intentional trauma to the ear To cite this article [

Prevalence of Foreign Body in the Otolaryngology Service in Ado Ekiti

“…The remarkable complications seen in the foreign bodies in the ear in this study were bleeding, traumatic perforated tympanic membrane and hearing impairment. Similarly, these complications were observed in another study [24]. These complications arose from the foreign body or the attempted efforts to remove it.…”

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

“…10 Our observation is also in accordance with study of Adegbiji from Nigeria, revealed that conductive hearing loss was the most common type of hearing impairment accounted for 326(61.6%), followed by sensorineural hearing loss 134(25.3%), while the common degree of hearing impairment was mild to moderate degree of hearing loss that accounted for 249(47.1%). 15 In present study spontaneous healing took place in 97 patients (85.1%), however amongst surgical procedures overlay myringoplasty was commonest (7, 6.1%) in those where perforation persisted beyond six months, which is keeping with Wani's work where overall spontaneous healing was achieved in 91.1% patients, and tympanoplasty was performed in 8(2.3%) patients. 17 According to available literature spontaneous healing of TTMP occurs in 80 -100% cases.…”

“…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). 15 These results are also supported by studies of Sogebi and Wani. 16,17 The left ear predominance can be explained as during interpersonal assault left is more close to assaulter.…”

“…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).…”

The association of iron deficiency anemia on chronic suppurative otitis media in children: A case-control study

“…In this study, it was found that most CSOM patients complained of otorrhea which was similar to a previous study that 19.6% of CSOM patients complained of otorrhea [ 3 ]. Otorrhea is the most common symtomp complain by CSOM patients caused by a long-lasting inflammatory process in the middle ear increasing proinflammatory cytokines such as TNF-α and IL-8 causes mucus cell metaplasia/hyperplasia resulting in increased secretion of fluid in the middle ear [ 26 , 27 ]. A study by Singh et all found 25% of CSOM patients had subtotal tympanic membrane perforation [ 28 ].…”