Kumar Rajendran Dinesh
Department of ENT and Head-Neck Surgery, PD Hinduja Sindhi Hospital, Sampangi Rama Nagar, Bengaluru, Karnataka 560027 India.
Indian J Otolaryngol Head Neck Surg. 2019 Nov;71(Suppl 2):1126-1134. doi: 10.1007/s12070-017-1239-6. Epub 2017 Dec 2.
Trauma in the form of instrumentation, slap, blast, accident, and sporting injury can result in tympanic membrane (TM) perforations which spontaneously recover in 53-94%. The closure rates of TM perforation due to above causes do not vary greatly; however, some otolaryngologists prefer to perform immediate microsurgical procedures to accelerate the recovery process. Our aim is to study the efficacy of Trichloroacetic acid (TCA) Chemical Cauterization (50%) and Platelet rich fibrin (PRF) Plug Myringoplasty technique in healing traumatic tympanic membrane perforations. To evaluate the preoperative and postoperative hearing outcome from the procedure and compare them. Study design is prospective study. A pilot study was carried out amongst selected 25 patients with central perforations in the Department of ENT, for duration of 2 years from July 13 to July 15. All 25 patients underwent PTA assessment & TCA (50%) and Autologous PRF Plug Myringoplasty technique done and follow up to 6 months postoperatively. The success rate traumatic tympanic membrane closure was found to be 92%. Pre- and post-operative hearing assessments of each patient were done & showed statistically significant air-bone gap closure with success rate of 88% ( < 0.05). From this study, the closure rate in traumatic tympanic membrane perforation by TCA (50%) and PRF Plug Myringoplasty technique was 92% with statistically significant hearing improvement (88%). This technique can be recommended as a time and cost effective office based procedure for treatment of traumatic tympanic membrane perforations.
器械损伤、掌击、爆炸、事故及运动损伤等形式的创伤可导致鼓膜穿孔,其中53%-94%可自行愈合。上述原因导致的鼓膜穿孔闭合率差异不大;然而,一些耳鼻喉科医生更倾向于立即进行显微外科手术以加速恢复过程。我们的目的是研究三氯乙酸(TCA,50%)化学烧灼和富血小板纤维蛋白(PRF)封堵鼓膜成形术治疗外伤性鼓膜穿孔的疗效。评估该手术术前和术后的听力结果并进行比较。研究设计为前瞻性研究。在耳鼻喉科选定25例中央穿孔患者中进行了一项为期2年的试点研究,时间从7月13日至7月15日。所有25例患者均接受了纯音听阈评估,并实施了50%TCA化学烧灼和自体PRF封堵鼓膜成形术,术后随访6个月。发现外伤性鼓膜闭合成功率为92%。对每位患者进行了术前和术后听力评估,结果显示气骨导差闭合具有统计学意义,成功率为88%(P<0.05)。从这项研究来看,50%TCA和PRF封堵鼓膜成形术治疗外伤性鼓膜穿孔的闭合率为92%,听力改善具有统计学意义(88%)。该技术可作为一种经济高效的门诊手术推荐用于治疗外伤性鼓膜穿孔。