Orji F T, Agu C C
Department of Otolaryngology, Federal Medical Center Umuahia, Abia State, Nigeria.
Clin Otolaryngol. 2008 Oct;33(5):420-6. doi: 10.1111/j.1749-4486.2008.01764.x.
To analyse the various factors influencing spontaneous healing of traumatic tympanic membrane perforation in West Africa.
Prospective clinical study.
Tertiary referral centre.
Consecutive patients with traumatic tympanic membrane perforations without history of previous middle ear disease.
Healing outcome at 4, 8, 12 weeks; effects of perforation size, location, and mode of injury, active intervention and ear discharge on healing outcome.
Fifty-three patients, 32 (60%) men and 21 (40%) women, aged 2-86 years, with traumatic tympanic membrane perforation who met our inclusion criteria were analysed. Ninety-four percent of the perforations healed spontaneously. Spontaneous healing was significantly correlated with age (P < 0.05). It was significantly delayed by large perforations estimated at 50% or more of entire tympanic membrane, ear discharge, wrong intervention on acute perforation by ear syringing, and by penetrating injuries sustained through the ear canal (P < 0.05, P < 0.01, P < 0.01 and P < 0.01 respectively). Perforations in the anterior versus posterior quadrants showed no significant difference in the healing rate (P > 0.05). Non-healing of the traumatic perforation was significantly associated with the large perforations, ear discharge and wrong intervention by ear syringing in chi-square test (P = 0.01, P = 0.02 and P < 0.001 respectively), but only with penetrating injuries sustained through the ear canal and the ear syringing intervention in logistic regression test (P = 0.02 and P = 0.04 respectively).
The rate of spontaneous healing of traumatic tympanic membrane perforation varied inversely with age of patient and size of perforation. It was delayed by middle-ear infection, as well as in ears that sustain direct injuries and in ears that had wrong interventions. However, it was not dependent on whether the perforation was in the anterior or posterior location. Logistic regression analysis revealed that penetrating injuries sustained through the ear canal and the ear syringing intervention were the only risk factors important in predicting the non-healing of traumatic tympanic membrane perforation.
分析影响西非外伤性鼓膜穿孔自然愈合的各种因素。
前瞻性临床研究。
三级转诊中心。
连续性外伤性鼓膜穿孔患者，既往无中耳疾病史。
4周、8周、12周时的愈合结果；穿孔大小、位置、损伤方式、积极干预及耳部流脓对愈合结果的影响。
分析了53例符合纳入标准的外伤性鼓膜穿孔患者，年龄2 - 86岁，其中男性32例（60%），女性21例（40%）。94%的穿孔自然愈合。自然愈合与年龄显著相关（P < 0.05）。穿孔面积估计占整个鼓膜50%或更多、耳部流脓、急性穿孔时用耳针冲洗进行错误干预以及经耳道的穿透性损伤会显著延迟愈合（分别为P < 0.05、P < 0.01、P < 0.01和P < 0.01）。鼓膜前象限与后象限穿孔的愈合率无显著差异（P > 0.05）。在卡方检验中，外伤性穿孔不愈合与大穿孔、耳部流脓及用耳针冲洗进行错误干预显著相关（分别为P = 0.01、P = 0.02和P < 0.001），但在逻辑回归检验中，仅与经耳道的穿透性损伤及耳针冲洗干预相关（分别为P = 0.02和P = 0.04）。
外伤性鼓膜穿孔的自然愈合率与患者年龄及穿孔大小呈负相关。中耳感染、遭受直接损伤的耳朵以及接受错误干预的耳朵会延迟愈合。然而，愈合与否并不取决于穿孔位于前侧还是后侧。逻辑回归分析显示，经耳道的穿透性损伤及耳针冲洗干预是预测外伤性鼓膜穿孔不愈合的仅有的重要危险因素。
