The effects of everted or inverted edges on healing of traumatic-induced tympanic membrane perforations.

OBJECTIVES: To evaluate the healing and hearing outcomes related to the everted or inverted edge area on slap- and fist-induced large tympanic membrane perforations. METHODS: A total of 120 patients with slap- or fist-induced tympanic membrane perforations, with inverted or everted edges, affecting 50-75 per cent of the entire tympanic membrane, were randomly divided into 2 groups: an edge approximation group and a spontaneous healing group. The edge approximation group was divided into subgroups A and B based on the reversed edge area (reversed edge was more or less than 50 per cent of the total perforation, respectively). Healing outcomes and hearing improvements at six months were compared. RESULTS: The data of 118 patients were analysed. The closure rate of perforations in subgroup A, subgroup B, and the spontaneous healing group was 90.9 per cent, 92.1 per cent and 84.5 per cent, respectively; the difference between the three groups was not significant (p = 0.393). CONCLUSION: The area of reversed edges for slap- or fist-induced tympanic membrane perforations did not seem to affect healing and hearing outcomes, regardless of edge approximation and everted or inverted edges.

Analysis of nasal foreign bodies in 341 children.

OBJECTIVE: This study aimed to analyse the common presentations and treatment outcomes in cases involving nasal foreign bodies. METHODS: A retrospective study was carried out over three years, from January 2014 to December 2017. Patient biodata, clinical presentation, nasal foreign body type and management outcome data were obtained from the medical records and analysed. RESULTS: A total of 341 cases were analysed. The average patient age was 3.7 ± 1.2 years (range, 1-19 years).Of the nine cases involving button batteries, septal perforation was initially seen in four cases and three cases had subsequent septal perforation. CONCLUSION: Only button battery nasal foreign bodies were associated with increased septal perforation. Use of physiological seawater nasal spray was found to reduce the likelihood of septal perforation. Most nasal foreign bodies could be removed under local anaesthesia.

Does epistaxis with an unknown bleeding site originate from the posterior part of the nasal cavity?

OBJECTIVE: To review the origins of epistaxis in patients with unknown bleeding sites. METHODS: This consecutive case series included 26 patients with unknown bleeding sites previously considered to have posterior epistaxis. All patients had previously been examined endoscopically at least once, and were again examined with 30°, 45° and 70° endoscopes. RESULTS: The bleeding site was at the: anterior end of the lateral wall of the inferior meatus in one patient (3.8 per cent); anterosuperior lateral wall of the nasal cavity in five patients (19.2 per cent); anterior nasal cavity roof in seven patients (26.9 per cent); anterosuperior part of the cartilaginous septum in nine patients (34.6 per cent); ostium pharyngeum tubae in two patients (7.7 per cent); and anterior nasal base in two patients (7.7 per cent). The morphology of the bleeding point showed: nasal mucosa ulceration in 1 patient, isolated primary telangiectasia in 3 patients, prominent vessels in 5 patients and capillary angioma in 17 patients. CONCLUSION: Epistaxis originating from the anterosuperior nasal cavity and nasopharynx can be easily misdiagnosed as posterior epistaxis or unknown bleeding sites. Areas that should be considered as possible origins of epistaxis in cases with unknown bleeding sites were identified.

The diagnosis and management of supernumerary nasal teeth.

OBJECTIVE: To discuss the reasons for misdiagnosis of supernumerary nasal teeth. METHODS: Clinical data of four supernumerary nasal tooth patients were analysed retrospectively at visits to our otolaryngology department between 2005 and 2018. RESULTS: All four patients were male and had a supernumerary nasal tooth in the right nasal cavity. Three of the four patients had previously been misdiagnosed. All the supernumerary nasal teeth were surrounded by granulation tissue or hypertrophic nasal mucosa, and were subsequently confirmed by computed tomography and endoscopy. The granulation tissue or hypertrophic nasal mucosa was removed using microwave ablation, and the supernumerary nasal teeth successfully removed by endoscopy. CONCLUSION: Supernumerary nasal teeth are rare, and are usually misdiagnosed because such teeth are surrounded by hypertrophic nasal mucosa or granulation tissue. They can be confirmed by computed tomography and endoscopy.

The distribution of bleeding sites in idiopathic hidden arterial epistaxis.

OBJECTIVE: To determine the frequency distribution of bleeding sites in idiopathic hidden arterial epistaxis. METHODS: In this retrospective cohort study, 107 patients with hidden arterial epistaxis were endoscopically examined for sites of bleeding. RESULTS: All sites of hidden arterial epistaxis were identified by endoscopic examination. Bleeding sites were identified at initial surgery in 103 patients and during the second surgery in 4. The bleeding sites included: the olfactory cleft region in 47 patients, the inferior meatus region in 29, the middle meatus region in 11, multiple bleeding sites (olfactory cleft and anterior septum) in 3, the anterior roof of the nasal cavity in 4, the nasal floor in 11 and the nasopharynx in 2. The bleeding points showed a white or red volcano-like bump in 75 patients, isolated prominent telangiectasia in 21 and mucosal ulceration in 11. CONCLUSION: Common sites of hidden arterial epistaxis include the olfactory cleft, inferior meatus and middle meatus. However, there should be awareness of some uncommon bleeding sites (including the anterior roof of the nasal cavity, the nasal floor and the nasopharynx) and of multiple bleeding sites.

Regeneration of the tympanic membrane using fibroblast growth factor-2.

OBJECTIVE: A systematic review was conducted to investigate the effectiveness of fibroblast growth factor-2 on the regeneration of tympanic membrane perforation. METHODS: The PubMed database was searched for relevant studies. Experimental studies, human randomised controlled trials, prospective single-arm studies and retrospective studies reporting acute and chronic tympanic membrane perforations in relation to two healing outcomes (success rate and closure time), were selected. RESULTS: All 11 clinical studies investigating the effect of fibroblast growth factor-2 on traumatic tympanic membrane perforations in humans reported a success rate of 89.3-100 per cent, with a closure time of around 2 weeks. Three studies of fibroblast growth factor-2 combined with Gelfoam showed that the success rate of chronic tympanic membrane perforation was 83-98.1 per cent in the fibroblast growth factor-2 group, but 10 per cent in the gelatine sponge groups. CONCLUSION: Fibroblast growth factor-2 with or without biological material patching promotes regeneration in cases of acute and chronic tympanic membrane perforation, and is safe and efficient. However, the best dosage, application time and administration pathway of fibroblast growth factor-2 are still to be elucidated.

Healing outcomes of large (>50%) traumatic membrane perforations with inverted edges following no intervention, edge approximation and fibroblast growth factor application; a sequential allocation, three-armed trial.

OBJECTIVE: The goal of this study was to evaluate the effects of perforation edge approximation and direct application of basic fibroblast growth factor (bFGF) each alone on the healing of large traumatic tympanic membrane perforations with inverted edges in humans. STUDY DESIGN: Prospective, sequential allocation, three-armed, controlled clinical study. SETTING: University-affiliated teaching hospital. PARTICIPANTS: Fifty-eight patients with large traumatic tympanic membrane perforations (i.e. affecting >50% of the surface area) with inverted edges were recruited. They were sequentially allocated to three groups: no intervention (n = 18), edge approximation alone (n = 20) and direct application of bFGF (n = 20). Otoscopy were performed before the treatment and at follow-up visits. MAIN OUTCOME MEASURES: The closure rate, closure time and rate of otorrhoea. RESULTS: Application of bFGF yielded a significantly higher average rate of perforation closure (100%) than edge approximation (60%) and no intervention (56%) (P < 0.05). It also significantly shortened the average closure time (12.4 ± 3.6 days) as compared to edge approximation (46.3 ± 8.7 days) and no intervention control (48.2 ± 5.3 days) (P < 0.05). Purulent otorrhoea was observed in none of the three groups. CONCLUSION: Edge approximation of inverted edges has little benefit in improving the healing outcome of large traumatic tympanic membrane perforations and thus is not an ideal treatment option for large traumatic tympanic membrane perforations. Application of bFGF materially improves the closure rate of large traumatic tympanic membrane perforations and significantly shortens the closure time.

A prospective study evaluating spontaneous healing of aetiology, size and type-different groups of traumatic tympanic membrane perforation.

OBJECTIVES: To evaluate the outcome of spontaneous healing of aetiology-, size- and type-different groups of acute traumatic eardrum perforation and to characterise changes in the morphology of the healing eardrum in various conditions. STUDY DESIGN: Prospective clinical study. SETTING: University-affiliated teaching hospital. PARTICIPANTS: A total of 126 patients who visited the Outpatient Department of the Otolaryngology Clinic of Yiwu Central Hospital, Yiwu, China between January 2008 and June 2009 with acute traumatic tympanic membrane perforations. MAIN OUTCOME MEASURES: All participants were allowed to heal spontaneously for 12 months. The clinical outcome including healing rate, healing time, hearing function and air-bone gap recovery as well as morphological changes of the healing tympanic membrane was evaluated on the bases of perforation aetiology, size and type, etc. RESULTS: By perforation size, the overall healing rate at the end of the 12-month follow-up was comparable to each other in the three (small, medium and large) size groups (P > 0.05); however, there were significant perforation size-dependent differences in the average closure time (P < 0.05). For serosanguinous discharge and dry perforations, the healing rate at the end of 12-month follow-up was similar (95%versus 85%, P > 0.05), but the average healing time was different (16 versus 28 days, P < 0.01) and so was the sequence of granulation tissue formation and epithelial migration in the course of perforation healing. The inverted or everted edges as compared with no curled edges did not significantly affect the healing rate (95%versus 82%, P > 0.05) or closure time (24 versus 27 days). Hearing loss differed significantly between perforations of different causes (P < 0.01), but the perforation cause did not affect recovery of the air-bone defect. Pre-existing tympanosclerosis was the most prominent cause of healing failure. CONCLUSION: The clinical outcome of spontaneous healing of acute tympanic membrane perforations is generally associated with perforation size, aetiology and whether dry or with a serosanguenous discharge. The sequence of granulation tissue formation and epithelial migration differs during the healing of traumatic tympanic membrane formation in serosanguinous discharge conditions and dry perforation.

A randomised controlled trial comparing spontaneous healing, gelfoam patching and edge-approximation plus gelfoam patching in traumatic tympanic membrane perforation with inverted or everted edges.

OBJECTIVE: To compare the outcome of patients with dry traumatic tympanic membrane perforation after spontaneous healing and gelfoam patching with or without perforation edge approximation. DESIGN: Prospective clinical study. SETTING: University-affiliated teaching hospital. PARTICIPANTS: Ninety-one patients with acute dry traumatic tympanic membrane perforation inverted or everted edges were recruited. They were randomly allocated to three groups: spontaneous healing (n=31), gelfoam patching (n=30) and edge-approximation plus gelfoam patching (n=30). Otoscopy and tympanometry were performed before the treatment and at follow-up visits. MAIN OUTCOME MEASURES: Healing rate, healing time, ear infection rate and morphological changes during healing process. RESULTS: The overall healing rate was 85% in the spontaneous healing group, lower than that in the two gelfoam patching groups (97%), but the difference failed to reach a statistical significance (P>0.05). The average healing time was 30 ± 10.1 days in the spontaneous healing group, significantly longer (P<0.01) than that in the other two groups (16 ± 5.6 and 18 ± 4.7 days, respectively). Middle ear infection rate did not differ significantly (7%, 3% and 3%, respectively). Spontaneous healing resulted in formation of scabs at the perforation edges, which was effectively prevented by gelfoam patching. CONCLUSIONS: Gelfoam patching may facilitate healing of traumatically perforated tympanic membrane. Approximation of folded perforation edges is not necessary in gelfoam patching.