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：大多数创伤性鼓膜穿孔(traumatic tympanic membrane perforations)的边缘呈内翻或外翻状态，但内翻与外翻边缘对鼓膜(tympanic membrane)自发性愈合的影响仍存在争议。研究目的：本研究旨在探讨内翻或外翻边缘对创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创伤性鼓膜穿孔患者的临床病历，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例存在内翻或外翻鼓膜边缘，48例无此类表现。在148例存在内翻/外翻鼓膜边缘的患者中，77例穿孔边缘为外翻型，44例为内翻型，17例为下垂型，10例同时存在内翻与外翻边缘。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%。有无内翻/外翻鼓膜边缘组间的穿孔闭合率及闭合时间均无显著差异；在12个月随访期末，有无边缘对合(edge approximation)组间的穿孔闭合率及闭合时间同样无显著差异。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/外翻的鼓膜边缘可逐渐发生坏死，但并未对愈合进程产生影响。此外，边缘对合并未改善创伤性鼓膜穿孔的愈合效果。