Ballivet de Régloix Stanislas, Crambert Anna, Salf Eric, Maurin Olga, Pons Yoann, Clément Philippe
Percy Military Training Hospital, ENT - Head and Neck Surgery Department, 101, Avenue Henri Barbusse, Clamart, France.
Legouest Military Training Hospital, ENT - Head and Neck Surgery Department, 27, Avenue de Plantieres, Metz Cedex 3, France.
Mil Med. 2018 Nov 1;183(11-12):e624-e627. doi: 10.1093/milmed/usy055.
Blast injuries in modern warfare are common, and tympanic perforation is often found. Spontaneous closures of large perforations that encompass greater than 80% of the tympanic surface are rare. Early closure of the tympanic membrane avoids the immediate infectious risk, which potentially complicates the initial management of these war-wounded patients, and allows for safe and early recovery of military activity. This study compared the outcomes of spontaneous closures and early biomembrane myringoplasty in subjects with large blast injury-induced tympanic perforation following a massive explosion.
This is a retrospective, observational, cohort study military troops with large barotraumatic tympanic membrane perforation. The study investigates early surgical tympanoplasty versus observation for spontaneous closure. The hearing loss, tympanic perforation closure rate, and closure time were noted.
Fourteen patients (19 ears) were referred from May 2008 to April 2017, and 6 patients (9 ears) underwent early myringoplasty. A total of 89% (n = 8) and 100% (n = 9) of the ears exhibited successful sealing of the perforation at one and 6 mo, respectively. In contrast, 60% (n = 6) of the 10 ears (8 patients) without initial myringoplasty did not heal spontaneously at 6 mo, and these ears underwent a delayed tympanoplasty procedure. Notably, patients with early myringoplasty suffered lower conductive hearing loss and fewer functional signs remotely.
Early myringoplasty using a biomembrane for blast injury-induced large tympanic perforation is a fast and minimally invasive method to achieve earlier tympanic closure and a higher closure rate for safe recovery of activity. It can be performed under general anesthesia concurrently with surgery for additional body-wide trauma. The deployment of ENT surgeons on the battlefield in the French Army has enabled early management of these patients.
现代战争中爆炸伤很常见，鼓膜穿孔也经常出现。鼓膜表面超过80%的大穿孔自发闭合很罕见。鼓膜早期闭合可避免直接感染风险，这种风险可能使这些战伤患者的初始治疗复杂化，并有助于安全、早日恢复军事活动。本研究比较了在大规模爆炸后发生大的爆炸伤性鼓膜穿孔的受试者中，自发闭合与早期生物膜鼓膜成形术的效果。
这是一项对患有大的气压创伤性鼓膜穿孔的军事人员进行的回顾性观察队列研究。该研究调查了早期手术鼓膜成形术与观察等待自发闭合的情况。记录了听力损失、鼓膜穿孔闭合率和闭合时间。
2008年5月至2017年4月转诊了14例患者（19耳），其中6例患者（9耳）接受了早期鼓膜成形术。分别有89%（n = 8）和100%（n = 9）的耳朵在1个月和6个月时穿孔成功封闭。相比之下，10耳（8例患者）未进行初始鼓膜成形术的患者中，60%（n = 6）在6个月时未自发愈合，这些耳朵接受了延迟鼓膜成形术。值得注意的是，早期进行鼓膜成形术的患者传导性听力损失较低，远期功能体征较少。
对于爆炸伤引起的大鼓膜穿孔，使用生物膜进行早期鼓膜成形术是一种快速且微创的方法，可实现更早的鼓膜闭合和更高的闭合率，以安全恢复活动。它可在全身麻醉下与其他全身创伤手术同时进行。法国军队在战场上部署耳鼻喉科医生能够对这些患者进行早期治疗。
