Department of Otorhinolaryngology, Yiwu Central Hospital, Zhejiang Department of Pathology, Yiwu Central Hospital, Zhejiang, China.
Clin Otolaryngol. 2011 Oct;36(5):450-60. doi: 10.1111/j.1749-4486.2011.02387.x.
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.
Prospective clinical study.
University-affiliated teaching hospital.
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.
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.
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.
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.
评估不同病因、大小和类型的急性外伤性鼓膜穿孔的自发愈合结果，并描述各种情况下愈合鼓膜的形态变化。
前瞻性临床研究。
大学附属教学医院。
2008 年 1 月至 2009 年 6 月期间，共有 126 名患者因急性外伤性鼓膜穿孔到中国义乌市中心医院耳鼻喉科门诊就诊。
所有患者均允许自行愈合 12 个月。根据穿孔病因、大小和类型等，评估临床结果，包括愈合率、愈合时间、听力功能和骨气导间隙恢复以及愈合鼓膜的形态变化。
根据穿孔大小，在随访结束时，三组（小、中、大）的总体愈合率相似（P>0.05）；然而，平均愈合时间存在显著的穿孔大小依赖性差异（P<0.05）。对于浆液血性分泌物和干燥性穿孔，12 个月随访结束时的愈合率相似（95%对 85%，P>0.05），但平均愈合时间不同（16 天对 28 天，P<0.01），且穿孔愈合过程中肉芽组织形成和上皮迁移的顺序也不同。与无卷曲边缘相比，翻转或外翻边缘并未显著影响愈合率（95%对 82%，P>0.05）或愈合时间（24 天对 27 天）。不同病因引起的听力损失差异有统计学意义（P<0.01），但穿孔病因不影响骨气导间隙的恢复。存在先前的鼓膜硬化症是愈合失败的最主要原因。
急性鼓膜穿孔的自发愈合临床结果通常与穿孔大小、病因以及是否为浆液血性分泌物或干燥性穿孔有关。在浆液血性分泌物和干燥性穿孔条件下，鼓膜外伤性穿孔愈合过程中，肉芽组织形成和上皮迁移的顺序不同。
