Jellinge M E, Kristensen S, Larsen K
Department of Anaesthesiology,Head and Neck Surgery,Hospital of Southwest Jutland,Esbjerg,Denmark.
Department of Otorhinolaryngology,Head and Neck Surgery,Hospital of Southwest Jutland,Esbjerg,Denmark.
J Laryngol Otol. 2015 Oct;129(10):950-4. doi: 10.1017/S0022215115002303. Epub 2015 Sep 7.
The treatment of traumatic tympanic membrane perforations varies in different investigations, ranging from observation to early surgical repair. The present study aimed to focus on the closure rate and the closure time in a group of patients treated with a watchful waiting policy.
The study comprised 133 consecutive patients with a total of 137 perforations. Data were evaluated in terms of aetiology, location and size of perforation, audiometric findings, closure rate, and closure time.
The overall closure rate was 97 per cent. For patients with a known closure time within three months, the median closure time was between three and four weeks. The probability of spontaneous closure over time was further analysed with Kaplan-Meier plots, for those perforations with known closure times and for all perforations including those with unknown closure times. Perforation size was the only significant determining factor for closure time.
Small perforations had a high probability of spontaneous closure within three to four weeks, justifying a watchful waiting policy. Larger uncomplicated perforations might warrant early surgical repair, depending on the patient's needs and the availability of surgery.
在不同的研究中，外伤性鼓膜穿孔的治疗方法各不相同，从观察到早期手术修复。本研究旨在关注一组采用观察等待策略治疗的患者的愈合率和愈合时间。
该研究纳入了133例连续患者，共137处穿孔。对病因、穿孔的位置和大小、听力检查结果、愈合率和愈合时间等数据进行了评估。
总体愈合率为97%。对于已知在三个月内愈合的患者，中位愈合时间在三到四周之间。采用Kaplan-Meier曲线进一步分析了随着时间推移自发愈合的概率，包括已知愈合时间的穿孔以及所有穿孔（包括愈合时间未知的穿孔）。穿孔大小是愈合时间的唯一重要决定因素。
小穿孔在三到四周内有很高的自发愈合概率，这证明了观察等待策略的合理性。较大的无并发症穿孔可能需要早期手术修复，这取决于患者的需求和手术的可及性。
