Identification and management of inverted or everted edges of traumatic tympanic membrane perforations

Abstract Introduction: Most of traumatic tympanic membrane perforations have inverted or everted edges, however, the effects of inverted and everted edges on the spontaneous healing of the eardrum remain controversial. Objective: We investigated the influence of inverted or everted edges on the spontaneous healing of traumatic tympanic membrane perforations. Methods: The clinical records of patients with a traumatic tympanic membrane perforations who met the study criteria were retrieved and categorized into two groups, based on whether the eardrum was inverted or everted. The features along the edge of each inverted or everted eardrum were described using 30º and 70º endoscopes. Results: In total, 196 patients (196 ears) met the inclusion criteria; of these, 148 had inverted or everted eardrums while 48 did not. Of the 148 patients with inverted or everted eardrums, the perforation edges were everted in 77 patients, inverted in 44 patients, drooping in 17 patients, and both inverted and everted in 10 patients. The perforation shape was triangular in 18.9% of patients, sector-shaped in 11.5%, kidney-shaped in 14.2%, ovoid in 20.3%, and irregularly shaped in 35.1% of patients. The difference was not significant between the with and without inverted/everted eardrum edges groups in terms of the closure rate or closure time. Similarly, the difference was not significant between the with and without edge approximation groups in terms of the closure rate or closure time at the end of the 12-month follow-up period. Conclusion: This study suggests that endoscopic inspection can clearly identify inverted/everted eardrum edges using 30º and 70º endoscopes. The edge is glossy in inverted/everted eardrums, whereas the edge is rough and irregular in non-inverted/everted cases. The inverted/everted eardrums gradually became necrotic, but this did not affect the healing process. Additionally, edge approximation did not improve the healing outcome of traumatic tympanic membrane perforations.

摘要 引言：绝大多数外伤性鼓膜穿孔（traumatic tympanic membrane perforations）存在边缘内翻或外翻的情况，但内翻与外翻边缘对鼓膜自发性愈合的影响仍存在争议。
研究目的：本研究旨在探讨边缘内翻或外翻对外伤性鼓膜穿孔自发性愈合的影响。
研究方法：检索符合纳入标准的外伤性鼓膜穿孔患者临床病历，根据鼓膜边缘是否内翻或外翻分为两组；采用30°及70°内窥镜（endoscope）对每例内翻/外翻鼓膜的边缘特征进行观察描述。
研究结果：共计196例患者（196耳）符合纳入标准，其中148例存在鼓膜内翻或外翻，48例无此表现。在148例存在鼓膜内翻/外翻的患者中，穿孔边缘外翻者77例，内翻者44例，下垂者17例，同时存在内翻与外翻者10例。穿孔形状分布为：三角形占18.9%、扇形占11.5%、肾形占14.2%、卵圆形占20.3%、不规则形占35.1%。存在与不存在内翻/外翻鼓膜边缘的两组患者，在鼓膜闭合率（closure rate）及闭合时间（closure time）上均无显著差异；同样，在12个月随访（follow-up）期末，存在与不存在边缘对合的两组患者，其闭合率及闭合时间也无显著差异。
研究结论：本研究表明，采用30°及70°内窥镜可清晰识别鼓膜内翻/外翻边缘。内翻/外翻的鼓膜边缘呈光滑光泽状，而非内翻/外翻病例的边缘则粗糙且不规则。内翻/外翻的鼓膜会逐渐发生坏死，但这并不会对愈合进程产生影响。此外，边缘对合并未改善外伤性鼓膜穿孔的愈合效果。