Traumatic perforation of the tympanic membrane: Etiologies and risk factors for healing and intervention

OBJECTIVE: To study various etiologies of traumatic tympanic membrane perforation; evaluate the factors involved in healing of traumatic tympanic membrane perforation; and identify patients with perforations unlikely to benefit from conservative management.METHODS:Design: Prospective observational studySetting: Tertiary Government Medical College and HospitalParticipants: 64 consecutive cases of traumatic tympanic membrane perforation seen over one year were followed for 3 months. Perforations were assessed in terms of size, etiology, condition of edge and other associated factors or combinations of factors with regards to spontaneous healing using descriptive statistics and chi-square tests.RESULTS: Of the 64 cases, 51 perforations healed while 13 did not. There were significant associations between tympanic membrane condition after 3 months and explosive mode of injury (?2 = 23.30; p=.00001) as well as with size of perforation ((?2 = 25.75; p=.00001). The risk of persistence of a tympanic membrane perforation was 34.57 times more among patients with a perforation size >50% compared to those with perforation size ?50% [OR-34.57 (6.28, 190.14); p= .00001]. Combined, explosive etiology and perforation size >50% were significantly associated with non-healing ((?2 = 37.60; p = .00001). There were no significant associations with the condition of the edge of the perforation and upper respiratory tract infection.CONCLUSIONS: An explosive etiology and tympanic membrane perforation size >50% may be significant risk factors predicting non-healing of the perforation. Risk stratification of patients having one or both of these risk factors with early intervention for those with both, and close monitoring for those with any one of these may lessen unnecessary morbidity. Bigger multicenter future studies are necessary to confirm these initial findings.

Bilateral congenital lacrimal fistulas in an adult as part of ectrodactyly-ectodermal dysplasia-clefting syndrome: A rare anomaly.

Ectrodactyly‑ectodermal dysplasia and clefting syndrome or “Lobster claw” deformity is a rare congenital anomaly that affects tissues of ectodermal and mesodermal origin. Nasolacrimal duct (NLD) obstruction with or without atresia of lacrimal passage is a common finding of such a syndrome. The authors report here even a rarer presentation of the syndrome which manifested as bilateral NLD obstruction and lacrimal fistula along with cleft lip and palate, syndactyly affecting all four limbs, mild mental retardation, otitis media, and sinusitis. Lacrimal duct obstruction and fistula were managed successfully with endoscopic dacryocystorhinostomy (DCR) which is a good alternative to lacrimal probing or open DCR in such a case.

Lateral rhinotomy for a large, infected haller cell causing proptosis

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To report a case of a large sinus Haller cell that presented with chronic rhinosinusitis and proptosis and its surgical management.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Case Report<br /><strong>Setting:</strong> Tertiary Government Hospital<br /><strong>Patient:</strong> One<br /><strong>RESULTS:</strong> A 34-year-old lady with proptosis and secondary sinusitis due to a giant infected Haller cell was successfully treated by lateral rhinotomy approach and clearance of all diseased mucosa therein into the nasal cavity.<br /><strong>CONCLUSION:</strong> Approach to diseased sinonasal structures via lateral rhinotomy is an alternative to endoscopic sinus surgery in the presence of an unusually large Haller cell.</p>