Traumatic rupture of the tympanic membrane: diagnosis, therapy and prognosis – a retrospective analysis
23 April 2019 (online)
Traumatic perforations of the tympanic membrane (tpt) are frequent emergencies in otolaryngology. They can occur due to cleaning ears or beats on the ear and can range from minor ruptures to injury of all quadrants of the membrane. Treatment is often inconsistent and can be done by splinting and tamponade of the ear canal.
We performed a retrospective analysis from 2012 to 2017 in the patient record of the ENT department Ulm. Only patients with at least one follow-up in our clinic were considered. The mechanism of rupture, localization in the membrane, treatment, time course and outcome were evaluated.
We included 115 patients with tpt. Beats on the ear were the most common cause with 44%. 148 tpt received a splint, mostly with a silicone film. On average the removal of the tamponade was after 22 days. In 59 cases (40%) the eardrum was already closed when the tamponade was removed. 83 cases showed a persistent perforation, which closed spontaneously in 35 and persisted in 12 cases (8%) in follow up examinations. The remaining had no further controls. The duration of splinting increased the probability of occlusion of the tympanic membrane. Water as a cause of tpt showed significantly worse healing than foreign bodies or beats. Most commonly, the anterior lower quadrant was affected (46%). Small tpt were significantly more frequently occluded after removal of tamponade. The timing of splinting did not matter for the cure. The cure rate of patients without splint was 76%.
Spontaneous healing is possible after traumatic ruptures of the tympanic membrane even without therapy. A comparison of the two groups is limited due to discrepancy of case numbers and should be investigated in a prospective study.