Heitmann D, Scheffler B, Abrams J, Gerstner A O H
Klinik für Hals‑, Nasen- und Ohrenheilkunde, Klinikum Braunschweig, Holwedestraße 16, 38118, Braunschweig, Deutschland.
HNO-Praxis, Rietberg, Deutschland.
HNO. 2021 Mar;69(3):192-197. doi: 10.1007/s00106-020-00991-1. Epub 2021 Jan 15.
Traumatic eardrum perforation is a common presentation in otorhinolaryngologic practices and emergency clinics. A consistent management strategy (active intervention vs. watchful waiting) is, however, still lacking.
In the following study, the outcome of watchful waiting is analyzed and presented.
A collective of 272 patients presenting at two different specialist ENT practices within days of traumatic tympanic membrane perforation from June 2002 to March 2019 were analyzed. Treatment was non-surgical, with prospective monitoring. Whereas antibiotics were not given at all in one practice, they were given only upon signs of infection in the other practice. The outcome was evaluated retrospectively on the basis of patient files.
The collective consisted of 185 males and 87 females. Mean age was 30 years (range: 7 months to 82 years). The perforations were most commonly located in the upper anterior and lower posterior quadrants. According to Griffin grading, the size was grade I in 97%. The three most common causes were impact to the ear, barotrauma, and foreign bodies. Under a watchful waiting regimen, 95% of the patients presenting for follow-up checks showed complete closure.
Watchful waiting can be assessed as appropriate in traumatic eardrum perforation, provided otorhinolaryngologic follow-up is ensured. An exception is blast injury, which is now much less common in Central Europe, as this is associated with a risk of secondary cholesteatomas. In these rare cases, active treatment with surgical exploration of the middle ear including relining the perforation is indicated.
外伤性鼓膜穿孔是耳鼻喉科门诊和急诊常见的病症。然而，目前仍缺乏一致的治疗策略（积极干预与观察等待）。
在本研究中，分析并展示观察等待的治疗结果。
分析了2002年6月至2019年3月期间在两家不同的耳鼻喉专科门诊就诊的272例外伤性鼓膜穿孔患者。治疗采用非手术方式，进行前瞻性监测。其中一家门诊完全不使用抗生素，另一家门诊仅在出现感染迹象时使用抗生素。根据患者病历对治疗结果进行回顾性评估。
该组患者包括185名男性和87名女性。平均年龄为30岁（范围：7个月至82岁）。穿孔最常见于上前象限和下后象限。根据格里芬分级，97%的穿孔为I级。最常见的三个病因是耳部撞击、气压伤和异物。在观察等待方案下，95%前来复诊的患者鼓膜完全愈合。
在外伤性鼓膜穿孔中，只要确保耳鼻喉科随访，观察等待可被视为一种合适的治疗方法。爆炸伤是个例外，在中欧这种情况现在已不太常见，因为它与继发性胆脂瘤的风险有关。在这些罕见病例中，建议积极治疗，包括中耳手术探查并修复穿孔。
