Spontaneous Healing Of Traumatic Eardrum Perforation: Outward Epithelial Cell Migration And Clinical Outcome

Abstract

OBJECTIVE: To characterize the otoendoscopic features of traumatic tympanic membrane perforations (TMPs) with outward-migrating epithelium at the perforation edges and to evaluate the spontaneous healing outcome of this type of perforation. STUDY DESIGN: Case series with chart review. SETTING: Tertiary university hospital. MATERIALS AND METHODS: The clinical records of traumatic TMP patients who met the case selection criteria were retrieved and categorized based on the documented migration pathways of the proliferating epithelial cells at the perforation margins into 2 groups: centripetal migration and outward migration. The demographic data and spontaneous healing outcomes (ie, healing rate and time) of these 2 types of TMP were analyzed using the chi-square test or t-test. The otoendoscopic features were characterized. RESULTS: In all, 122 cases were analyzed. During the spontaneous healing process, perforations were associated with centripetal epithelial cell migration in 87 (71.3%) cases and with outward epithelial cell migration in 35 (28.7%) cases. The overall perforation closure rates at the end of 6 months were 97% and 94% for the centripetal and outward migration groups, respectively (P > 0.05). The average perforation closure times were 18.4 ± 3.7 and 37.6 ± 9.2 days, respectively (P < 0.05). CONCLUSIONS: Although the outward epithelial migration did not affect the overall perforation spontaneous healing rate, it alone could not close the perforation. The prerequisite for eardrum healing is that the outward epithelium migration pattern evolves into a centripetal migration pattern. Consequently, outward epithelial migration prolonged substantially the time to traumatic eardrum perforation closure.