Elsevier

American Journal of Otolaryngology

Volume 34, Issue 4, July–August 2013, Pages 282-286
American Journal of Otolaryngology

Original contribution
Late crust formation as a predictor of healing of traumatic, dry, and minor-sized tympanic membrane perforations

https://doi.org/10.1016/j.amjoto.2012.12.006Get rights and content

Abstract

Objective

The goal of this study was to evaluate the effects of crust formation on the healing of traumatic, dry, and minor-sized tympanic membrane perforations (TMPs) in humans.

Study design

Case series with a chart review.

Setting

Tertiary university hospital.

Materials and methods

The clinical records of patients with traumatic TMPs who met the case selection criteria were retrieved and categorized according to the presence of a crust and the timing of crust formation into three groups: no crust, early crust formation, and late crust formation. Healing outcomes (i.e., healing rate and time) in the three groups were analyzed.

Results

In total, 83 patients were analyzed. The perforation closure rates were 92%, 100%, and 78% in the groups with no-crust, early crust formation, and late crust formation, respectively. No significant difference was seen between the groups with no-crust and with late crust formation (p > 0.05). By contrast, closure rates differed significantly between the early and late crust formation groups (p < 0.05). Overall, the no-crust and early crust formation groups showed shorter healing times compared with the late crust formation group (p < 0.05). However, closure times did not differ significantly between groups with early crust formation and no crust (p > 0.05).

Conclusions

Crust formation at the margin of a traumatic TMP may serve as a predictor of healing outcome. Compared with perforations with early crust formation or no crust, late crust formation can result in delayed healing and failure to close completely.

Introduction

Epithelial migration on the tympanic membrane (TM) and external auditory canal (EAC) has been observed in humans and other animals [1], [2]. Epithelial migration is necessary to remove debris such as keratin and foreign bodies from the TM [3], [4] because a crust or foreign matter on the TM may disturb the pattern of TM vibration. Similarly, any crust that forms during the healing process of traumatic TM perforations (TMPs) must move from the healing eardrum to the EAC via epithelial migration. Previous studies of TM epithelial migration have focused on migration rates and patterns; to the best of our knowledge, no study has investigated how crust formation affects eardrum healing. Therefore, we investigated two main research questions: What kind of crust formed, if any, and did crust formation affect eardrum healing?

In this study, we used an endoscope to observe the formation of crusts during the healing process of traumatic TMPs in humans; we also compared how the presence or lack of crust formation affected the closure of traumatic TMPs.

Section snippets

Ethical considerations

The study protocol, including access to and use of medical records, was approved by the Institutional Ethics Committee of Wenzhou Medical College-Affiliated Yiwu Hospital.

Case selection

The clinical records of patients with traumatic TMPs who presented to the Otolaryngology Outpatient Clinic of Wenzhou Medical College-Affiliated Yiwu Hospital in China between September 2010 and September 2011 were accessed through the Records Department of the hospital. Cases that met the following inclusion criteria were

Demographic data

The study recruited 143 consecutive patients who suffered injuries or blows to the ear resulting in acute TM perforations: 60 patients were excluded based on appropriate criteria. Ultimately, 83 cases (34 males, 49 females) who met the inclusion criteria were analyzed.

The patients were divided into three groups depending on the presence of a crust and the timing of crust formation: no crust (24 patients, 29%), early crust formation (within 1 week of injury; 32 patients, 39%), and late crust

Discussion

The timing and rate of spontaneous healing in traumatic TMPs are known to depend on several factors [5], [6], [7]. In this study, some confounding factors (e.g., size, location, mechanism of perforation, sex, and age) were excluded.

Our findings suggest that TM healing is associated with the presence and timing of crust formation at the perforation margin. Participants with early crusting exhibited a higher rate of healing (100% vs. 78%) and a shorter healing time (18.2 vs. 38.1 days) compared

Conclusions

Based on the above results, we conclude that early crusts appear to be related to blood otorrhea or an everted eardrum edge and seem to accelerate eardrum healing. By contrast, late crusts are related to the excessive desquamation and outward migration of epidermal cells, possibly sealing perforation edges and preventing perforation closure mechanically, thereby resulting in delayed healing of a traumatic TMP, or even failure to close. Simply put, early crusts appear to be a good sign, and late

References (16)

  • M. Dyson et al.

    Comparison of the effects of moist and dry conditions on dermal repair

    J Invest Dermatol

    (1988)
  • K.K. Deong et al.

    Epithelial migration of the postmyringoplasty tympanic membrane

    Otol Neurotol

    (2006)
  • I.P. Tang et al.

    Epithelial migration in the atelectatic tympanic membrane

    J Laryngol Otol

    (2009)
  • P.W. Alberti

    Epithelial migration on the tympanic membrane

    J Laryngol Otol

    (1964)
  • D. Boedts et al.

    Epithelial migration on the tympanic membrane: an experimental study

    Acta Otolaryngol

    (1978)
  • F.T. Orji et al.

    Determinants of spontaneous healing in traumatic perforations of the tympanic membrane

    Clin Otolaryngol

    (2008)
  • Z.C. Lou et al.

    A prospective study evaluating spontaneous healing of aetiology, size and type-different groups of traumatic tympanic membrane perforation

    Clin Otolaryngol

    (2011)
  • S. Kristensen

    Spontaneous healing of traumatic tympanic membrane perforations in man: a century of experience

    J Laryngol Otol

    (1992)
There are more references available in the full text version of this article.

Cited by (13)

  • The effect of epidermal growth factor on the pseudo-healing of traumatic tympanic membrane perforations

    2021, Brazilian Journal of Otorhinolaryngology
    Citation Excerpt :

    Lou et al.19 believe that the healing tympanic membrane exhibits different patterns of granulation tissue formation and proliferating epithelium migration in dry and wet perforations; the healing begins with physiological migration of the proliferating epithelium under dry conditions, and with granulation tissue formation in wet environments. Lou20,21 found that the healing of dry perforations causes outward epithelial cell migration and crust formation, which impedes perforation healing and prolongs the healing time. Poor healing of the tympanic membrane occurs mainly in dry perforations.

  • Comparison of biodegradable synthetic polyurethane foam versus Gelfoam packing in cartilage graft myringoplasty procedures

    2020, Auris Nasus Larynx
    Citation Excerpt :

    Shoman N et al [13] also found that BSPF provided gentle compression and offered sufficient wound support during the critical healing period through the absorption of fluids and blood. The blood clots contain multiple growth factors and aid the healing of wound and graft [18–20]. In addition, BSPF provide a moist graft environment within the EAC through the absorption of exudation and blood, which was similar to the report of Jang SY et al in dacryocystorhinostomy study [17].

  • The need for a better indicator of when FGF-2 should be applied to treat subacute tympanic membrane perforations

    2017, American Journal of Otolaryngology - Head and Neck Medicine and Surgery
  • Comparative study of epidermal growth factor and observation only on human subacute tympanic membrane perforation

    2019, American Journal of Otolaryngology - Head and Neck Medicine and Surgery
    Citation Excerpt :

    Although most of subacute TMPs showed closure of some degree during the first two months, these perforations didn't achieve to completely close, some perforations showed the excessive proliferation of epithelium at the perforation edge. Previous studies suggested that the outward migration and excessive proliferation of epithelium at the perforation edge resulted in failed or delayed healing of human subacute TMPs [17,18]. The results showed that the topical application of FGF significantly improved the closure rate and shortened the closure time compared to observation only.

View all citing articles on Scopus
View full text