Spandow O, Hellström S, Dahlström M, Bohlin L
Department of Otorhinolaryngology, Umeå University Hospital, Sweden.
J Laryngol Otol. 1995 Nov;109(11):1041-7. doi: 10.1017/s0022215100131986.
Thirty consecutive patients with permanent perforations of their tympanic membranes (TM) present from 2.5 to 50 years (mean 18.7 years) were admitted to a prospective study using two alternative methods of dressings for closure of the perforations. An adhesive-coated hydrocolloid material was compared with a conventional dressing of vaseline impregnated rice paper patch after de-epithelialization of the perforation border. Nine of the permanent TM perforations (30 per cent), five with the hydrocolloidal dressing and four with the rice paper patch had healed when followed-up after one year. The size of eight of the central perforations that had healed was equal to or less than 25 per cent of the TM. Also one perforation with a size of 65 per cent had healed. Seven perforations were located in the posterior part of the TM: four in the posterior-superior quadrant, one in the inferior quadrant, one had engulfed the posterior half of the TM and one included the anterior-inferior quadrant. Only two perforations out of 14, with a size of 25 per cent or less, located in the anterior-inferior quadrant, healed. No significant difference was demonstrated between the two types of dressings. Both groups noted an immediate improvement in hearing of 10.8 and 9.3 dB, respectively, after application of the dressing. The study demonstrates that application of an occlusive dressing or paper patch in 30 per cent of patients can promote the healing of long-standing perforations. The chances for healing are better if the perforation is located in the posterior part of the TM. This simple technique immediately improved hearing and should be tried before a patient is referred for myringoplasty surgery.
30例鼓膜（TM）永久性穿孔患者，穿孔时间为2.5至50年（平均18.7年），被纳入一项前瞻性研究，该研究采用两种替代敷料方法来闭合穿孔。在穿孔边缘去上皮化后，将一种涂有粘合剂的水胶体材料与传统的凡士林浸渍米纸贴片敷料进行比较。随访一年后，9例永久性TM穿孔（30%）愈合，其中5例使用水胶体敷料，4例使用米纸贴片。愈合的8个中央穿孔的大小等于或小于TM的25%。此外，一个大小为65%的穿孔也已愈合。7个穿孔位于TM的后部：4个位于后上象限，1个位于下象限，1个覆盖了TM的后半部，1个包括前下象限。位于前下象限的14个穿孔中，只有2个大小为25%或更小的穿孔愈合。两种敷料之间未显示出显著差异。两组在应用敷料后听力均立即分别提高了10.8 dB和9.3 dB。该研究表明，在30%的患者中应用闭塞性敷料或纸贴片可促进长期穿孔的愈合。如果穿孔位于TM的后部，愈合的机会更大。这种简单的技术能立即改善听力，在患者被转诊进行鼓膜成形术之前应尝试使用。
