Determinants of spontaneous healing in traumatic perforations of the tympanic membrane.

OBJECTIVES: To analyse the various factors influencing spontaneous healing of traumatic tympanic membrane perforation in West Africa.

STUDY DESIGN: Prospective clinical study.

SETTING: Tertiary referral centre.

PARTICIPANTS: Consecutive patients with traumatic tympanic membrane perforations without history of previous middle ear disease.

MAIN OUTCOME MEASURES: Healing outcome at 4, 8, 12 weeks; effects of perforation size, location, and mode of injury, active intervention and ear discharge on healing outcome.

RESULTS: Fifty-three patients, 32 (60%) men and 21 (40%) women, aged 2-86 years, with traumatic tympanic membrane perforation who met our inclusion criteria were analysed. Ninety-four percent of the perforations healed spontaneously. Spontaneous healing was significantly correlated with age (P < 0.05). It was significantly delayed by large perforations estimated at 50% or more of entire tympanic membrane, ear discharge, wrong intervention on acute perforation by ear syringing, and by penetrating injuries sustained through the ear canal (P < 0.05, P < 0.01, P < 0.01 and P < 0.01 respectively). Perforations in the anterior versus posterior quadrants showed no significant difference in the healing rate (P > 0.05). Non-healing of the traumatic perforation was significantly associated with the large perforations, ear discharge and wrong intervention by ear syringing in chi-square test (P = 0.01, P = 0.02 and P < 0.001 respectively), but only with penetrating injuries sustained through the ear canal and the ear syringing intervention in logistic regression test (P = 0.02 and P = 0.04 respectively).

CONCLUSION: The rate of spontaneous healing of traumatic tympanic membrane perforation varied inversely with age of patient and size of perforation. It was delayed by middle-ear infection, as well as in ears that sustain direct injuries and in ears that had wrong interventions. However, it was not dependent on whether the perforation was in the anterior or posterior location. Logistic regression analysis revealed that penetrating injuries sustained through the ear canal and the ear syringing intervention were the only risk factors important in predicting the non-healing of traumatic tympanic membrane perforation.