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