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The integrity of the tympanic membrane is an important factor when deciding treatment and therapeutic recommendations for dogs with ear disease; however, otoscopic examination may be difficult to perform due to features of external ear canal disease or patient compliance. CT is useful for the evaluation of middle ear disease, including cases in which middle ear disease is detected incidentally. The tympanic membrane is detectable using CT, but anecdotally, apparent focal defects or discontinuities of the tympanic membrane are often seen in patients with and without ear disease. The purpose of this prospective, observer agreement study was to determine if perforations of the tympanic membrane are reliably detectable on CT. Fifteen cadaver dogs underwent CT and video otoscopy to verify the integrity of each tympanic membrane. Cadavers were randomly assigned to have the tympanic membranes left intact or to undergo a myringotomy on either the left, the right, or both sides. CT was performed immediately following the myringotomies. Four blinded evaluators evaluated the pre- and post-myringotomy scans for a total of 30 scans (60 tympanic membranes). Average accuracy was low (44%), and interobserver agreement for all four evaluators was fair. Although the tympanic membrane is visible on CT, perforations of the tympanic membrane are unlikely to be accurately detected or excluded. The appearance of an intact tympanic membrane or defect in the membrane on CT should not be used as criteria to guide clinical treatment recommendations based on this cadaver model., (© 2024 American College of Veterinary Radiology.)

The tympanic membrane (i.e. eardrum) sits at the interface between the middle and external ear. The tympanic membrane is composed of three layers: an outer ectoderm-derived layer, a middle neural crest-derived fibroblast layer with contribution from the mesoderm-derived vasculature, and an inner endoderm-derived mucosal layer. These layers form a thin sandwich that is often perforated following trauma, pressure changes or middle ear inflammation. During healing, cells need to bridge the perforation in the absence of an initial scaffold. Here, we assessed the contribution, timing and interaction of the different layers during membrane repair by using markers and reporter mice. We showed that the ectodermal layer is retracted after perforation, before proliferating away from the wound edge, with keratin 5 basal cells migrating over the hole to bridge the gap. The mesenchymal and mucosal layers then used this scaffold to complete the repair, followed by advancement of the vasculature. Finally, differentiation of the epithelium led to formation of a scab. Our results reveal the dynamics and interconnections between the embryonic germ layers during repair and highlight how defects might occur., Competing Interests: Competing interests The authors declare no competing or financial interests., (© 2024. Published by The Company of Biologists Ltd.)

Objective: Size, an important characteristic of a tympanic membrane perforation (TMP), is commonly assessed with gross estimation via visual inspection, a practice which is prone to inaccuracy. Herein, we demonstrate feasibility of a proof-of-concept computer vision model for estimating TMP size in a small set of perforations., Methods: An open-source deep learning architecture was used to train a model to segment and calculate the area of a perforation and the visualized tympanic membrane (TM) in a set of endoscopic images of mostly anterior and relatively small TMPs. The model then computed relative TMP size by calculating the ratio of perforation area to TM area. Model performance on the test dataset was compared to ground-truth manual annotations. In a validation survey, otolaryngologists were tasked with estimating the size of TMPs from the test dataset. The primary outcome was the average absolute error of model size predictions and clinician estimates compared to sizes determined by ground-truth manual annotations., Results: The model's average absolute error for size predictions was a 0.8% overestimation for all test perforations. Conversely, among the 38 survey respondents, the average clinician error was a 11.0% overestimation (95% CI, 5.2-16.7%, p = 0.003)., Conclusions: In a small sample of TMPs, we demonstrated a computer vision approach for estimating TMP size is feasible. Further validation studies must be done with significantly larger and more heterogenous datasets., Level of Evidence: N/A Laryngoscope, 134:2906-2911, 2024., (© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: To investigate the technique of personalized flap making under otoscopy and its clinical application. Methods: The clinical data of patients who underwent 301 Military Hospital myringoplasty in the Department of otoendoscopic surgery, Department of Otorhinolaryngology, head and neck surgery, Department of Otorhinolaryngology, from October 2022 to 2023 August were analyzed retrospectively, all enrolled patients were performed independently by the same skilled otoendoscopic surgeon. The patients' general condition, medical history, tympanic membrane perforation scope, perforation size, need for tympanic cavity exploration, thickness of skin flap, tympanic cavity lesion scope, skin flap making method and postoperative rehabilitation were collected. Results: Many factors such as the location of tympanic membrane perforation, the thickness of the skin flap, the degree of curvature or stricture of the ear canal and the extent of the lesion in the tympanic cavity should be considered in the manufacture of the individualized tympanic membrane skin flap, the way of skin flap making does not affect the long-term postoperative rehabilitation, but it can effectively avoid unnecessary ear canal skin flap injury and improve the operation efficiency. Conclusion: Scientific flap fabrication is important for improving surgical efficiency and enhancing surgical confidence., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Objectives: To investigate if prophylactic antibiotics (PA) in conjunction with myringoplasty of clean and uninfected ears entails a reduction of postoperative infections within 6 weeks after surgery, and whether it affects the healing rate of the tympanic membrane (TM) at follow-up, 6-24 months after surgery., Design: A retrospective cohort study of prospectively collected data., Setting: Data extracted from The Swedish Quality Register for Ear Surgery (SwedEar), the years 2013-2019., Participants: All patients in SwedEar with a registered clean conventional myringoplasty (tympanoplasty type I) including a follow-up visit., Main Outcome Measures: The effect of PA use on TM healing rate at follow-up and postoperative infection within 6 weeks of surgery., Results: In the study group (n = 1665) 86.2% had a healed TM at follow-up. There was no significant difference between the groups that had PA administered (87.2%) or not (86.1%). A total of 8.0% had a postoperative infection within 6 weeks. Postoperative infection occurred in 10.2% of the group that received PA (n = 187) compared with 7.7% of the group that did not receive PA. However, this difference was not statistically significant. Postoperative infection within 6 weeks significantly lowered the frequency of healed TMs., Conclusion: PA administered during clean conventional myringoplasty does not improve the chance of having a healed TM at follow up, nor decrease the risk of having a postoperative infection within 6 weeks after surgery., (© 2023 The Authors. Clinical Otolaryngology published by John Wiley & Sons Ltd.)

Objectives: We explored the auditory and anatomical success of grafting when the cartilage perichondrium (CP) was prepared using two different methods., Methods: Patients with subtotal or total perforation underwent tympanoplasty with a CP graft. A V -shaped groove for the handle of the malleus was prepared for CP grafts in patients in group 1. Patients in group 2 did not have a groove on the graft. The anatomical success of the graft was evaluated as success, partial success, or failure. Results of auditory evaluations were compared between the two groups., Results: A total of 195 patients were included in the study. The total CP graft integration rate was 96% for both groups. Significant changes were detected in all hearing criteria evaluated 12 months after surgery compared to the preoperative period ( P  < .05). There were no significant differences between the groups in terms of the relationship between graft technique and postoperative hearing results. However, rates of partial success were significantly higher for group 1 than group 2 ( P  = .033)., Conclusion: Cartilage slice support offers an extremely reliable method for reconstruction of tympanic membrane in cases of high-risk perforation. Partial failures are rare, but when they occur, they most often involved anterior graft medialization. When a piece of cartilage is removed at the malleus interface there may be a higher rate of partial failure.

Introduction: The external auditory canal (EAC) packing is widely used in otosurgery and is considered to promote hemostasis and to support tympanic membrane grafts. However, few studies have investigated the effects of packing removal time on healing., Objective: We investigated the effect of EAC packing duration on healing after endoscopic cartilage myringoplasty in patients with chronic tympanic membrane perforations (TMPs)., Materials and Methods: Patients with chronic TMPs who underwent endoscopic "push-through" cartilage myringoplasty were divided into early and late groups based on the length of time before EAC packing was removed. The graft success rate, eardrum appearance, and hearing gain were assessed 3 months after surgery., Results: The study included 137 patients. Three months after surgery, the graft success rate was 83.5% (66/79) in the early group and 94.8% (55/58) in the late group ( P = .042). The graft was displaced in 8 (10.1%) patients in the early group and in 1 (1.7%) patient in the late group ( P = .050). No epithelialization was found on the surface of the grafts in the early group, whereas epithelialization was nearly complete 4 weeks after surgery in the late group., Conclusions: Delaying removal of the EAC packing after endoscopic cartilage myringoplasty may promote tympanic membrane better healing and cartilage graft epithelialization and improve the appearance of the eardrum.

Background: The elevation of the tympanomeatal flap in endoscopic myringoplasty will cause considerable tissue damage., Objective: To analyze anatomic and audiological results of tympanic membrane perforation underwent endoscopic transtympanic cartilage push-through myringoplasty without tympanomeatal flap elevation (EPM) and their relationship with the size of perforation., Methods: A clinical retrospective study was performed on 75 cases of tympanic membrane perforation that underwent EPM from January 2019 to March 2021. Graft success and hearing outcomes were evaluated 3 months after surgery., Results: The overall graft success rate for EPM was 94.7% (71/75). The total rate of hearing success, postoperative ABG ≤ 20 dB was achieved in 96.0% (72/75). The overall mean AC threshold of 35.1 ± 5.6 dB was lowered to 25.0 ± 4.8 dB postoperatively ( p  < .01). The mean pre- and postoperative ABG of all patients were 20.5 ± 4.6 dB and 10.4 ± 3.9 dB ( p  < .01), respectively. The graft success rates for the small, middle and large perforations groups were 100% (11/11), 100% (34/34) and 86.7% (26/30), respectively., Conclusion: It is revealed that EPM is an effective method to repair perforation of tympanic membrane. The size of the tympanic membrane perforation may be a risk factor for perforation healing and hearing recovery, although EPM is available for large perforations.

Objectives/hypothesis: The aim of the study was to investigate the healing rates, the restoration of hearing, and the time for complete healing of paper patching versus watchful waiting for traumatic tympanic membrane perforations (TTMPs)., Study Design: Systematic review with meta analysis., Methods: Publications were selected by a search on "PubMed," "Embase," and "Web of Science." A meta-analysis of risk ratios for paper patching (intervention arm) and watchful waiting (control arm) was performed., Results: Five studies describing 393 TTMPs were included in the quantitative meta-analysis. TTMP healing rates ranged between 84.2% and 95.2% in the intervention arm and between 76.7% and 84.8% in the control arm. The pooled risk ratio of healed TTMPs was significantly higher in the intervention arm than in the control arm (risk ratio: 1.12, 95% confidence interval: 1.04-1.21)., Conclusions: TTMPs have high healing potential with and without intervention. The healing rate of paper patching was superior to that of watchful waiting alone., Level of Evidence: NA Laryngoscope, 131:2091-2097, 2021., (© 2021 The American Laryngological, Rhinological and Otological Society, Inc..)

Tympanic membrane (TM) perforation is a global clinical dilemma. It occurs as a consequence of object penetration, blast trauma, barotrauma, and middle ear diseases. TM perforation may lead to otitis media, retraction pockets, cholesteatoma, and conductive deafness. Molecular therapies may not be suitable to treat perforation because there is no underlying tissue matrix to support epithelium bridging. Chronic perforations are usually reconstructed with autologous grafts via surgical myringoplasty. Surgical treatment is uncomfortable for the patients. The grafting materials are not perfect because they produce an opaque membrane, fail in up to 20% of cases, and are suboptimal to restore acoustic function. Millions of patients from developing parts of the world have not got access to surgical grafting due to operational complexities, lack of surgical resources, and high cost. These shortcomings emphasize bioengineering to improve placement options, healing rate, hearing outcomes, and minimize surgical procedures. This review highlights cellular, structural, pathophysiological, and perforation specific determinants that affect healing, acoustic and surgical outcomes; and integrates necessities relevant to bioengineered scaffolds. This study further summarizes scaffolding components, progress in scaffolding strategies and design, and engenders limitations and challenges for optimal bioengineering of chronic perforation., (© 2021 IOP Publishing Ltd.)

Background: Untreated traumatic tympanic membrane perforations (TMPs) may lead to permanent perforations and hearing loss. There are many materials that have been previously used for repairing the TMPs., Aims and Objectives: The purpose of this study is to evaluate the clinical and histological effects of Vivosorb (Vv) and Epifilm on healing of TMPs in a rat model., Material and Methods: The posterior-inferior quadrant of the tympanic membranes (TMs) in right ears of 14 rats was perforated using a 20-g needle and then the animals were randomly divided into 2 equal groups (n = 7). The perforated right TMs were treated with either Vv (Vv group) or Epifilm (Ep group). The left TMs of 7 rats were perforated in same way and allowed to close spontaneously without any topical material applications (spontaneous closure group as sham control, SC). The left tympanic membranes of the other 7 rats were not perforated and used as normal controls (NC group). On postoperative 15th day, tympanic bullas were extracted from killed rats and examined morphometrically and histopathologically., Results: Perforation closure rate was 85.7% (6/7) in both Vv and SC groups. Perforations of Ep group closed in 7/7 (100%) ears. The thicknesses of the perforated membranes were increased in SC and especially Vv groups. Also, connective tissue fibrosis, blood clots, and epithelial degenerations were detected in SC and Vv groups. The mean fibroblastic reaction scores of Vv, Ep, and SC groups were 2.14(+), 0.57(+), and 1.71(+) respectively, on comparison with NC group. The mean neovascularization score was 1.42(+) in Vv group, 0.14(+) in Ep group, and 0.57(+) in SC group., Conclusion and Significance: Vivosorb and especially Epifilm can improve the healing process in traumatic TMPs and additionally, Epifilm might be more preferred for the treatment of TMPs because of causing lesser fibrosis.

Background: There is a lack of studies concerning chronic otitis media without cholesteatoma., Objectives: To perform an analysis of tympanic membrane perforations (TMP), compare the parameters of central and marginal TMP, combining both the traditional and more recent technologies available., Material and Methods: 792 consecutive patients. The TMP subgroups were divided by central and marginal locations and compared based on signs suggestive of previous tympanic retraction, namely, medialized malleus, tympanic remnants over the promontory, tympanic remnants over the ossicular chain, and incus/stapes erosion. Analysis of the status of the contralateral ear (CLE)., Results: Central TMP was diagnosed in 79.8%. Compared with the central group, the marginal group had more reported hearing loss (95.6%), greater conductive hearing loss (pure tone average for air-conduction 43.3 dB and average air-bone gap of 28.7 dB), a larger perforated area (46.45%), more posteroinferior quadrant involvement, a greater number retraction signs prior to the TMP, and more changes in the CLE (71%)., Conclusion: The differences between TMP subgroups are highlighted when we use all technologies available to compare them. Marginal TMPs have more altered parameters than central TMPs., Significance: There is a great possibility to enhance the knowledge of TMPs and to improve the pathogenesis-based treatment.

Purposes: This study provides an approach to estimating tympanic membrane perforation-induced hearing loss (HL) using a human middle ear model., Methods: Sixty-one cases of tympanic membrane perforation originating from fireworks were reported from the Ear-Nose-Throat Department. The otoscope, audiometry data and diagnosis records were organized, and gender, age, etiology, perforation size and diseased ear side were classified as independent variables. A multinomial regression model was used to analyze the potential effects of the variables on HL. Meanwhile, a human middle ear model was implemented to calculate the ensued HL resulting from different perforation areas and sites. In addition, linear regression models were used to establish functions between perforation size and HL., Results: The audiometry data indicate that HL at high frequencies (f > 2 kHz) is much more profound than that at the speech frequency band (f < 1 kHz). Compared with mild HL (<15 dB), mediate HL (15-30 dB) was correlated with the perforation area (p < 0.05, 95% CI), while severe HL (>30 dB) was affected by both perforation size and age (p < 0.05, 95% CI). However, other factors, including gender and diseased ear side, do not show a statistically significant effect on HL. Furthermore, the Kruskal-Wallis test result reveals that HL at frequencies of 0.25 kHz ≤ f ≤ 8 kHz is strongly associated with the perforation size (p < 0.05, 95% CI)., Conclusions: It is conclusive that HL is positively proportional to the perforation size. However, HL is not correlated with the perforation site for small perforation areas of < 10% (p > 0.05, 95% CI).

There is increasing interest in applications which use the 30 to 90 GHz frequency range, including automotive radar, 5 G cellular networks and wireless local area links. This study investigated pulsed 30-90 GHz radiation penetration into the human ear canal and tympanic membrane using computational phantoms. Modelling involved 100 ps and 20 ps pulsed excitation at three angles: direct (orthogonal), 30° anterior, and 45° superior to the ear canal. The incident power flux density (PD) estimation was normalised to the International Commission on Non-Ionizing Radiation Protection (1998) standard for general population exposure of 10 Wm -2 and occupational exposure of 50 Wm -2 . The PD, specific absorption rate (SAR) and temperature rise within the tympanic membrane was highly dependent on the incident angle of the radiation and frequency. Using a 30 GHz pulse directed orthogonally into the ear canal, the PD in the tympanic membrane was 0.2% of the original maximal signal intensity. The corresponding PD at 90 GHz was 13.8%. A temperature rise of 0.032° C (+20%, -50%) was noted within the tympanic membrane using the equivalent of an occupational standard exposure at 90 GHz. The central area of the tympanic membrane is exposed in a preferential way and local effects on small regions cannot be excluded. The authors strongly advocate further research into the effects of radiation above 60 GHz on the structures of the ear to assist the process of setting standards.

Introduction: There is no dose-response model available for the assessment of the risk of tympanic membrane rupture (TMR), commonly known as eardrum rupture, from exposures to blast from nonlethal flashbangs, which can occur concurrently with temporary threshold shift. Therefore, the objective of this work was to develop a fast-running, lumped parameter model of the tympanic membrane (TM) with probabilistic dose-dependent prediction of injury risk., Materials and Methods: The lumped parameter model was first benchmarked with a finite element model of the middle ear. To develop the dose-response curves, TMR data from a historic cadaver study were utilized. From these data, the binary probability response was constructed and logistic regression was applied to generate the respective dose-response curves at moderate and severe eardrum rupture severity., Results: Hosmer-Lemeshow statistical and receiver operation characteristic analyses showed that maximum stored TM energy was the overall best dose metric or injury correlate when compared with total work and peak TM pressure., Conclusions: Dose-response curves are needed for probabilistic risk assessments of unintended effects like TMR. For increased functionality, the lumped parameter model was packaged as a software library that predicts eardrum rupture for a given blast loading condition., (© Association of Military Surgeons of the United States 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: The peripheral auditory system and various structures within the central auditory system are vulnerable to blast injuries, and even blast overpressure is at relatively mild traumatic brain injury (TBI) level. However, the extent of hearing loss in relation to blast number and time course of post-blast is not well understood. This study reports the progressive hearing damage measured in chinchillas after multiple blast exposures at mild TBI levels (103-138 kPa or 15-20 psi)., Materials and Methods: Sixteen animals (two controls) were exposed to two blasts and three blasts, respectively, in two groups with both ears plugged with foam earplugs to prevent the eardrum from rupturing. Auditory brainstem response (ABR) and distortion product otoacoustic emission (DPOAE) were measured in pre- and post-blasts. Immunohistochemical study of chinchilla brains were performed at the end of experiment., Results: Results show that the ABR threshold and DPOAE level shifts in 2-blast animals were recovered after 7 days. In 3-blast animals, the ABR and DPOAE shifts remained at 26 and 23 dB, respectively after 14 days. Variation of auditory cortex damage between 2-blast and 3-blast was also observed in immunofluorescence images., Conclusions: This study demonstrates that the number of blasts causing mild TBI critically affects hearing damage., (© Association of Military Surgeons of the United States 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Aim: To establish whether covering the tympanic membrane perforation after war blast injury with silicon foil can enhance the ear drum healing rate and to determine the appropriate timing of silicon patching., Methods: We retrospectively analyzed the charts of 210 patients wounded during the Homeland War in Croatia 1991-1995, with 315 blast tympanic membrane perforations. In 44 patients (61 perforations), the eardrum perforation was covered by silicon foil, whereas in 166 patients (254 perforations) it was left to heal spontaneously. The patients who underwent the patching procedure were divided in two groups according to the time period between the blast injury and the procedure: 38 perforations were treated within 3 days and 23 perforations were treated 4 to 6 days after the blast injury., Results: The rate of tympanic membrane healing in the silicon foil patching group was significantly higher (91.8%) than that in the group of perforations left to heal spontaneously (79.9%, P=0.029). The healing rate was significantly higher in the group treated within 3 days after the blast injury (97.4%) than in the group treated 4 to 6 days after the injury (82.6%, P=0.042)., Conclusion: Covering the perforation after the war blast injury with silicon foil significantly improves the rate of tympanic membrane healing. To obtain the best healing outcome, the procedure should be performed within the first 72 hours after the trauma.

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.

The aim of this project was to investigate the effects of different types of graft material, and different remaining segments of the native TM on its motion. In twelve human temporal bones, controlled TM perforations were made to simulate three different conditions. (1) Central perforation leaving both annular and umbo rims of native TM. (2) Central perforation leaving only a malleal rim of native TM. (3) Central perforation leaving only an annular rim of native TM. Five different graft materials (1) perichondrium (2) silastic (3) thin cartilage (4) thick cartilage (5) Lotriderm® cream were used to reconstruct each perforation condition. Umbo and stapes vibrations to acoustic stimuli from 250 to 6349 Hz were measured using a scanning laser Doppler vibrometer. Results showed that at low frequencies: in the Two Rims condition, all grafting materials except thick cartilage and Lotriderm cream showed no significant difference in umbo velocity from the Normal TM, while only Lotriderm cream showed a significant decrease in stapes velocity; in the Malleal Rim condition, all materials showed a significant decrease in both umbo and stapes velocities; in the Annular Rim condition, all grafting materials except Lotriderm and perichondrium showed no significant difference from the Normal TM in stapes velocity. Umbo data might not be reliable in some conditions because of coverage by the graft. At middle and high frequencies: all materials showed a significant difference from the Normal TM in both umbo and stapes velocities for all perforation conditions except in the Annular Rim condition, in which silastic and perichondrium showed no significant difference from the Normal TM at umbo velocity in the middle frequencies. In the low frequencies, the choice of repair material does not seem to have a large effect on sound transfer. Our data also suggests that the annular rim could be important for low frequency sound transfer., Competing Interests: The authors have declared that no competing interests exist.

Hearing damage is one of most prevalent injuries in military personnel and civilians exposed to a blast. However, the mechanism of how the blast overpressure interacts with the tympanic membrane (TM) and impairs the peripheral auditory system still remains unclear. A 3D finite element (FE) model of the human ear has been developed to predict the blast overpressure transmission through the ear (Leckness et al., 2018), but the model needs to be further validated in TM response to blast pressure. This paper reports the first-ever approach using two laser Doppler vibrometers (LDVs) to measure the motion of the TM when the ear was exposed to a blast. Five fresh human temporal bones were used in this study with a pressure sensor inserted near the TM to measure the pressure reaching the TM (P1). The temporal bone was mounted in a "head block" and exposed to blast at the overpressure around 35 kPa measured at the entrance of the ear canal (P0). The movements of the TM at the umbo and the "head block" were measured simultaneously by two LDVs and the exact motion of the TM was determined by subtracting the head block motion from the TM data. Results include that the maximum TM velocity was 12.62 ± 3.63 m/s (mean ± SD) and the displacement was 0.78 ± 0.26 mm. The peak-to-peak displacement normalized by the P0 pressure was 22.9 ± 6.6 μm/kPa. The frequency domain analysis indicated that the spectrum peaks were located at frequencies below 3 kHz. The TM motion was then compared with that calculated from the FE model of the human ear with the measured P0 pressure wave applied at the ear canal entrance. The FE model-derived TM displacement under blast overpressure was consistent with the experimental results. This study provides a new methodology to determine the behavior of the middle ear in response to blast overpressure. The experimental data are critical for validating the FE model of the human ear for blast wave transduction and understanding the TM damage induced by blast exposure., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Traumatic tympanic membrane perforation (TTMP) is usually managed conservatively because most close spontaneously within a few months. Nevertheless, spontaneous closure of TTMP during long-term observation has not been well described in the literature., Objectives: The present study investigated factors associated with spontaneous closure of TTMP, and the characteristics of cases exhibiting spontaneous closure following long-term observation., Materials and Methods: The medical records of 40 patients with TTMP who visited the authors' hospital were retrospectively reviewed., Results: Spontaneous closure was observed in 27 (67.5%) patients. The healing period was <2 weeks in 6 cases, <4 weeks in 9, <3 months in 5, <6 months in 3, and ≥6 months in 4. All four cases in which spontaneous closure took ≥6 months exhibited a sign of spontaneous closure at 6 months following injury. Perforation in contact with the malleus was associated with a lower frequency of spontaneous closure., Conclusions and Significance: In TTMP, surgery should be considered in patients who exhibit perforation in contact with the malleus. However, it has also been suggested that long-term observation may be a viable treatment option when a sign of spontaneous closure is observed within 6 months following injury.

Objective: To determine whether an enrofloxacin-silver sulfadiazine emulsion (ESS) labeled for treatment of otitis externa in dogs has ototoxic effects in rabbits following myringotomy., Animals: 6 healthy adult New Zealand White rabbits., Procedures: Rabbits were anesthetized for brainstem auditory-evoked response (BAER) tests on day 0. Myringotomy was performed, and BAER testing was repeated. Saline (0.9% NaCl) solution and ESS were then instilled in the left and right middle ears, respectively, and BAER testing was repeated prior to recovery of rabbits from anesthesia. Application of assigned treatments was continued every 12 hours for 7 days, and rabbits were anesthetized for BAER testing on day 8. Rabbits were euthanized, and samples were collected for histologic (6 ears/treatment) and scanning electron microscopic (1 ear/treatment) examination., Results: Most hearing thresholds (11/12 ears) were subjectively increased after myringotomy, with BAER measurements ranging from 30 to 85 dB in both ears. All day 8 hearing thresholds exceeded baseline (premyringotomy) values; results ranged from 30 to 85 dB and 80 to > 95 dB (the upper test limit) in saline solution-treated and ESS-treated ears, respectively. All ESS-treated ears had heterophilic otitis externa, epithelial hyperplasia of the external ear canal, various degrees of mucoperiosteal edema, and periosteal new bone formation on histologic examination. Scanning electron microscopy revealed that most outer hair cells in the ESS-treated ear lacked stereocilia or were absent., Conclusions and Clinical Relevance: Results supported that ESS has ototoxic effects in the middle ear of rabbits. Further research is needed to confirm these findings. Myringotomized laboratory rabbits may be useful to study ototoxicity of drugs used in human medicine.

Objectives: Our preliminary study performed on perforated rat's tympanic membrane (TM) using Rat Wound Healing RT2 Profiler PCR Array showed significantly increased levels of mRNA for collagens type I and V. Enhanced expression of those genes does not assure that their protein products are indeed present, and in what quantity. Therefore, this study was undertaken to analyze the collagen type I and V content in the healing TM., Methods: Sixty rats were used, of which 10 served as controls and the others had their TM perforated. The experimental animals were divided into five subgroups on the basis of time points (03, 06, 09, 14, 20 day after injury). Videootoscopy and histology were employed to assess the morphology of the healing process. The expression of collagen type I and V was evaluated using Western blot analysis. Tissue localization of collagens was determined by the immunofluorescence method., Results: The collagen type I expression was three times higher on the third day after injury and remained on that level for whole period of observation, up to day 20. The increase of the collagen type V expression was gradual, reaching the highest level on day 14 following injury. In comparison to the control TM statistically significant increase in the level of expression was observed starting from day 09 to the end of observation period. In healing TM immunofluorescent labeling of collagen type I and V was seen on the surface of remnants of previous lamina propria and in the loose proliferating fibrous tissue. On day 20 immunofluorescence was present mainly on the surface of thin connective tissue layers forming the scar in the place of previous perforation., Conclusion: Although the collagens type I and V are present only in subepithelial layer in the normal rat's TM they play significant role in TM healing process., (Copyright © 2018. Published by Elsevier B.V.)

Hearing damage induced by blast exposure is a common injury in military personnel involved in most operation activities. Personal hearing protection devices such as earplugs come as a standard issue for Service members; however, it is not clear how to accurately evaluate the protection mechanisms of different hearing protection devices for blast overpressures (BOP). This paper reports a recent study on characterization of earplugs' protective function to BOP using human cadaver ears and 3D finite element (FE) model of the human ear. The cadaver ear mounted with pressure sensors near the eardrum (P1) and inside the middle ear (P2) and with an earplug inserted was exposed to BOP in the blast test chamber. P1, P2, and BOP at the ear canal entrance (P0) were simultaneously recorded. The measured P0 waveform was then applied at the ear canal entrance in the FE model and the P1 and P2 pressures were derived from the model. Both experiments and FE modeling resulted in the P1 reduction which represents the effective protection function of the earplug. Different earplugs showed variations in pressure waveforms transmitted to the eardrum, which determine the protection level of earplugs., (© Association of Military Surgeons of the United States 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives/hypothesis: To report on the safety and efficacy of cartilage-buttressed T-tube tympanoplasty for long-term middle ear ventilation, specifically by examining duration of tube survival, as well as adverse events associated with prolonged middle ear intubation, including persistent tympanic membrane perforation., Study Design: Retrospective case series of patients undergoing cartilage-buttressed T-tube tympanoplasty between January 2005 and December 2016 in a tertiary-care neurotology private practice., Methods: Patients who underwent cartilage T-tube tympanoplasty with complete pre- and postoperative audiometric data and a minimum follow-up duration of 12 months were analyzed. T-tube survival and adverse events including persistent tympanic membrane perforation were recorded and compared to published data for other long-term middle ear ventilation techniques., Results: The study cohort included 72 cartilage-buttressed T-tube tympanoplasties in 68 patients. Median tube survival was 34 months (range, 2-131 months). Incidence of persistent tympanic membrane perforation (n = 1) was 1.4% CONCLUSIONS: Cartilage-buttressed T-tube tympanoplasty is a safe and effective means of accomplishing long-term middle ear ventilation with a considerably lower rate of persistent tympanic membrane perforation as compared to alternative methods of prolonged middle ear ventilation., Level of Evidence: 4 Laryngoscope, 129:203-208, 2019., (© 2018 The American Laryngological, Rhinological and Otological Society, Inc.)

Introduction: Most of traumatic tympanic membrane perforations have inverted or everted edges, however, the effects of inverted and everted edges on the spontaneous healing of the eardrum remain controversial., Objective: We investigated the influence of inverted or everted edges on the spontaneous healing of traumatic tympanic membrane perforations., Methods: The clinical records of patients with a traumatic tympanic membrane perforations who met the study criteria were retrieved and categorized into two groups, based on whether the eardrum was inverted or everted. The features along the edge of each inverted or everted eardrum were described using 30° and 70° endoscopes., Results: In total, 196 patients (196 ears) met the inclusion criteria; of these, 148 had inverted or everted eardrums while 48 did not. Of the 148 patients with inverted or everted eardrums, the perforation edges were everted in 77 patients, inverted in 44 patients, drooping in 17 patients, and both inverted and everted in 10 patients. The perforation shape was triangular in 18.9% of patients, sector-shaped in 11.5%, kidney-shaped in 14.2%, ovoid in 20.3%, and irregularly shaped in 35.1% of patients. The difference was not significant between the with and without inverted/everted eardrum edges groups in terms of the closure rate or closure time. Similarly, the difference was not significant between the with and without edge approximation groups in terms of the closure rate or closure time at the end of the 12-month follow-up period., Conclusion: This study suggests that endoscopic inspection can clearly identify inverted/everted eardrum edges using 30° and 70° endoscopes. The edge is glossy in inverted/everted eardrums, whereas the edge is rough and irregular in non-inverted/everted cases. The inverted/everted eardrums gradually became necrotic, but this did not affect the healing process. Additionally, edge approximation did not improve the healing outcome of traumatic tympanic membrane perforations., (Copyright © 2017 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.)

Objective: To compare the outcomes of epidermal growth factor (EGF) and gelatin sponge patch treatments for traumatic tympanic membrane perforations., Study Design: Prospective, randomized, controlled., Setting: University-affiliated teaching hospital., Subjects and Methods: In total, 141 perforations encompassing >50% of the eardrum were randomly divided into 3 groups: EGF (n = 47), gelatin sponge patch (n = 47), and observation (n = 47). The edges of the perforations were not approximated. The closure rate, mean closure time, and infection rate were evaluated at 6 months and the related factors analyzed., Results: A total of 135 perforations were analyzed. At 6 months, the closure rates were 97.8%, 86.7%, and 82.2% in the EGF, gelatin sponge patch, and spontaneous healing groups, respectively ( P = .054). The mean ± SD closure time was 11.12 ± 4.60, 13.67 ± 5.37, and 25.65 ± 13.32 days in the EGF, gelatin sponge patch, and spontaneous healing groups, respectively ( P < .001). In addition, the presence of infection was not significantly associated with rate of closure in any group., Conclusions: As compared with spontaneous healing, daily application of EGF and gelatin sponge patching reduced the closure time of traumatic tympanic membrane perforations. EGF treatment had a higher closure rate and shorter closure time but resulted in otorrhea. By contrast, gelatin sponge patches did not improve the closure rate or cause otorrhea but required repeated patch removal and reapplication. Thus, the appropriate treatment should be selected according to patient need.

The authors aim to analyze the effects of oral antibiotic treatment for traumatic tympanic membrane perforations and to compare the outcomes of patients with traumatic tympanic membrane perforation after paper-patching procedure and spontaneous healing.In this study, 80 patients with traumatic tympanic membrane perforation diagnosed in the otorhinolaryngology emergency department and outpatient clinic from March 2010 to January 2015 were retrospectively reviewed. If the patient is diagnosed at first week and the edge of perforation is moist with blood, our routine procedure is paper-patching (group 1). However, if the patients reject treatment or delay in admission, the authors follow up patients for spontaneous closure (group 2). Some of the patients got oral antibiotics for 7 days (amoxicillin/clavulanic acid, 1000 mg 2 times/d) while some others did not. Closure rates and effectivity of oral antibiotics were evaluated and compared between 2 groups.In total, 80 patients were analyzed. The closure rates of perforations were 95.2% for group 1 (n = 42) and 81.6% for group 2 (n = 38). Although the paper-patched patients (group 1) perforation closure rate (95.2%) is higher than the nontreated patients (group 2) closure rate (81.6%), it is not statistically significant (P > 0.05). Antibiotic administered 55 patients had a significantly higher closure rate (94.5%) than the 25 patients who are not treated with antibiotics (76%) (P = 0.023; P < 0.05).In patients with traumatic tympanic membrane perforations, spontaneous closure rate is quite high. This study showed us that antibiotherapy and paper-patch treatments increase the healing rates.

Objective: The application of moisture to the ear is anecdotally claimed to relieve the pain from otic barotrauma that can arise during aircraft descent. This claim was tested in a randomised double-blind study on an aircraft with eight participants heavily predisposed to barotrauma., Methods: On the outward flight, half the participants wore 'active' devices that applied moisture to the external ear; the remainder wore placebo devices that contained no moisture, but were otherwise identical. On the return flight, the groups were reversed. Participants wore the devices from just before descent until landing, unless they experienced symptoms of barotrauma, in which case they switched to what they knew was an active device., Results: There were no significant differences between conditions regarding the appearance of the tympanic membrane on landing or the discomfort levels immediately before and after any switch., Conclusion: Applying moisture is ineffective for passengers heavily predisposed to otic barotrauma.

Objectives: To study the case characteristics of forensic medical identification of traumatic tympanic membrane perforations, and to discuss the key points of forensic medical identification and evaluations methods for tympanic membrane perforations., Methods: Twenty-four cases of traumatic tympanic membrane perforations accepted by the Academy of Forensic Science during 2017 were retrospectively analysed. The data of perforation size, form, predilection site, healing time and healing mode were evaluated., Results: For the traumatic tympanic membrane perforations, the study showed that the small size of perforation （<1/2 quadrant） with irregular shape was common. The location of perforations was almost on the anterior and inferior quadrant, and centripetal migration healing was common. The healing rate within 6 weeks was up to 90%., Conclusions: In the identification cases of traumatic tympanic membrane perforations, the key is to determine whether it is traumatic and whether it will heal spontaneously within 6 weeks. It is suggested to check the tympanic membrane weekly by an otic endoscope combined with acoustic impedance measurement at the sixth week, which can improve the accuracy, objectivity and scientificity of the identification., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Forensic Medicine.)

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.

Rupture of the eardrum or tympanic membrane (TM) is one of the most frequent injuries of the ear after blast exposure. To understand how the TM damage is related to blast wave direction, human cadaver ears were exposed to blast waves along three directions: vertical, horizontal, and front with respect to the head. Blast overpressure waveforms were recorded at the ear canal entrance (P0), near the TM (P1), and inside the middle ear (P2). Thirteen to fourteen cadaver ears were tested in each wave direction and the TM rupture thresholds were identified. Results show that blast wave direction affected the peak P1/P0 ratio, TM rupture threshold, and energy flux distribution over frequencies. The front wave resulted in lowest TM rupture threshold and the horizontal wave resulted in highest P1/P0 ratio. To investigate the mechanisms of TM injury in relation to blast wave direction, the recorded P1 waveforms were applied onto the surface of the TM in a three-dimensional finite element model of the human ear and distributions of the stress in TM were calculated. Modeling results indicate that the sensitivity of TM stress change with respect to P1 pressure (dσ/dP1) may characterize mechanical damage of the TM in relation to blast waves.

Background: Traumatic perforation of the tympanic membrane (TPTM) is often encountered in primary care or in the emergency department (ED). Several therapeutic interventions have been described, but conservative follow-up until spontaneous complete recovery is the most common choice., Objective: Our goal was to analyze the trauma mechanism, perforation characteristics, and outcome of patients with TPTM., Methods: The study included patients examined in the ED of a tertiary, university-affiliated medical center because of TPTM between 2012 and 2016. Their medical records were retrospectively reviewed for demographics, trauma mechanism, clinical characteristics, and outcome. A phone survey was performed to obtain the missing information of all the patients who did not continue their follow-up in our outpatient clinic., Results: We reviewed the histories of 80 patients with a mean age of 26.7 ± 14.6 years (20 children; 25%). TPTM was caused by blunt trauma in 45 patients (56%) and penetrating trauma in 35 patients (44%). Thirty-five patients (44%) completed their follow-up in the hospital outpatient clinic, with a mean duration of 6.2 weeks. Twenty-five patients (38%) completed their follow-up in a community-based otolaryngology clinic, 6 patients (9%) chose not to complete their follow-up, and 14 patients were lost to follow-up. Of the 60 patients who completed follow-up, 56 patients recovered spontaneously, 3 patients underwent successful tympanoplasty, and 1 patient was referred to surgery but was lost to follow-up. All children healed spontaneously., Conclusion: TPTM was more common in young males with main mechanisms of blunt trauma (an assault) or cleaning the ear canal. All children demonstrated complete spontaneous recovery., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objectives: To test the clinical and audiometric efficacy of a minimally invasive myringoplasty technique, combining cartilaginous palisades while avoiding flap elevation, for small and wide perforations., Methods: Over 4 years, this retrospective study included all patients over 6 years of age presenting an indication for myringoplasty. Several clinical and economic criteria were noted at 7 d, 2 months, 6 months and 2 years postoperative. The main outcome was the absence of perforation 2 years postoperative. The secondary outcomes were an audiometric gain at 6 months and the evaluation of the treatment cost., Results: Thirty patients underwent the minimally invasive technique and 28 patients the technique with an elevation of the tympanomeatal flap. The minimally invasive surgical procedure was shorter (p = .001). At 2 years, the tympanic closure rate was equivalent (95% versus 89.5%, p = .77). The audiometric gain was similar between the two techniques (p = .09). From a medico-economic point of view, the minimally invasive procedure was the most effective because it was three times less expensive than the conventional technique with no reduction in efficacy (p = .02)., Conclusion: This quick and easy technique could be developed in an ambulatory setting or even in conditions adapted to consultation.

Objective: Through analysis of the tympanic membrane perforation rate and hearing improvement rate with chronic suppurative otitis media (CSOM) by myringoplasty,to observe the effect of different preoperative conditions such as middle ear lesion,eustachian tube (ET) function and infection status on the postoperative curative effect. Method: Retrospective analysis of EENT Hospital of Fudan University from January 2012 to November 2016 during the 203 cases (203 ears) with clinical data of myringoplasty: according to intraoperative exploration of the presence of purulent secretions in the tympanic cavity,divided into infection active group and infection quiescence group; according to the preoperative results of the function of ET with acoustic impedance test divided into dysfunction or good group; according to the preoperative temporal bone HRCT suggested that the middle ear (mastoid cells,tympanic antrum and tympanic cavity) with or without soft tissue density,divided into the group with no focal lesion and the group with focal lesion. Review endoscopy and pure tone audiometry after 3 to 6 months. Using SPSS 19.0 statistical software to compare the differences among them of tympanic membrane perforation rate and hearing improvement rate. Result: Single factor analysis: ①The infection quiescence group of tympanic membrane perforation rate was 11.93%(13/109),higher than the infection active group ［8.51%(8/94)］; the infection quiescence group of hearing improvement rate was 75.23%(82/109),below the infection active group ［79.79%(75/94)］,no statistically significant differences of them ( P >0.05).②The group with dysfunction of ET of tympanic membrane perforation rate was 14.06%(9/64),significantly higher than the group［4.04%(4/99)］with good function ET,with statistical difference of them ( P <0.05); the group with dysfunction of ET of hearing improvement rate was 76.56% (49/64),lower than the group［81.82%(81/99)］with good function of ET,no significant difference of them ( P >0.05).③The group with no obvious lesion of tympanic membrane perforation rate was 9.09% (10/110),lower than the group ［11.83%(11/93)］with focal lesion; the group with no obvious lesion of hearing improvement rate was 78.18% (86/110),higher than the group with focal lesion ［76.34%(71/93)］,no significant difference of them ( P >0.05).Multivariate analysis: ①There was a significant correlation of postop-erative tympanic membrane perforation rate with preoperative ET functi-on ( P <0.05).There was no significant correlation of the postoperative tympanic membrane perforation rate with the infection status and the temporal bone HRCT images in the middle ear lesions ( P >0.05).②There was no significant correlation of the postoperative hearing improvement rate with the infection status,the ET function and the temporal bone HRCT images in the middle ear lesions ( P >0.05). Conclusion: Dysfunction of ET and localized lesions of the ear were more common in infection active;the accumulation of purulent exudate on the surface of the tympanic mucosa and localized lesions of the middle ear did not affect the healing rate of the tympanic membrane and the hearing improvement rate; ET function is one of the most important factors that affect the healing rate of tympanic membrane after operation,the patients with ET dysfunction are more likely to affect tympanic membrane perforation,but does not affect the hearing improvement rate., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

The rupture of tympanic membrane (TM) has long been viewed as an indicator of blast injury, especially for hearing loss. However, little is known about damage to the TM caused by blast with pressure lower than the rupture threshold. In this paper, we present our study on the effect of blast overpressure on the static mechanical properties of TM. Chinchilla was used as the animal model and exposed to multiple blasts with pressures lower than the rupture threshold of the TM. Using a micro-fringe projection method, we observed the alteration of the static mechanical properties of post-blast chinchilla's TMs as compared to those of control TMs. Specifically, after exposing to multiple blasts, the Young's modulus of chinchilla TM decreased by ∼53% while the ultimate failure pressure decreased by ∼33%. Scanning Electron Microscope (SEM) images show the damage formation in the post-blast TM as compared with its control counterpart., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Hypothesis: To examine the cellular events following induced superficial lesions of the human tympanic membrane (TM). Such information could lead to enhanced appreciation of repair mechanisms and novel strategies to restore TM perforations., Background: Persistent perforation of the TM in chronic otitis media is a major global health problem and frequently necessitates surgical intervention. Most TM perforations heal spontaneously and swiftly, but sometimes healing fails. The underlying mechanisms and the reason for incomplete repair are often elusive, although some mechanisms have been proposed., Methods: Here, five healthy adult human TMs were sampled during vestibular schwannoma surgery. Three days before harvesting, three TMs were superficially lesioned, including the epithelial and sub-epithelial layers, using a needle and two TMs served as controls. Light and transmission electron microscopy were performed., Results: Surrounding lesion showed distinct ultrastructural changes. This included a keratinocyte frontier with electron-dense cells with abundant ribosomes and nuclei metamorphosis. Beneath, were activated fibroblasts and invaded/transformed free cells and signs of increased transcellular activity of adjacent blood vessels., Conclusions: The study describes dynamic morphological events of a human lesioned TM. The human model may be used for further investigations and understanding of TM healing mechanisms.

Context: Middle ear barotrauma (MEB) is common during chamber compression in hyperbaric oxygen therapy. However, little evidence exists on an optimal compression protocol to minimize the incidence and severity of MEB., Objective: To compare the incidence of MEB during hyperbaric oxygen therapy using two different chamber compression protocols., Design: Double-blinded, randomized controlled trial., Setting: Hyperbaric Medicine Unit, The Townsville Hospital, Queensland, Australia, September 2012 to December 2014., Patients: 100 participants undergoing their first hyperbaric oxygen therapy session., Intervention: Random assignment to a staged (n=50) or a linear (n=50) compression protocols. Photographs of tympanic membranes were taken pre- and post-treatment and then graded. Middle ear barotrauma was defined as an increase of at least one grade on a modified TEED scale., Results: The observed MEB incidence under the staged protocol was 48% compared to 62% using the linear protocol (P=0.12, exact one-sided binomial test), and thus the staged protocol did not show a significant improvement in MEB. However, the staged protocol resulted in significantly less severe deteriorations in MEB grades when compared to the linear protocol (P=0.028, exact one-sided Mann-Whitney type test)., Conclusion: The use of the assessed staged compression protocol for the first hyperbaric oxygen treatment showed no significant effect on the overall incidence of MEB when compared to the gold standard linear protocol but resulted in a significant improvement in the severity of the experienced MEBs. Further studies are needed to elucidate an optimal compression protocol to minimize middle ear barotrauma., Competing Interests: The authors of this paper declare no conflicts of interest exist with this submission.

Objective: Identify associated clinical factors and characterize the various forms of hearing loss in the context of blast-related traumatic tympanic membrane (TM) perforation sustained in the combat setting., Methods: A prospective study of 41 patients who sustained a TM perforation secondary to blast injury between 2010 and 2012 while serving in combat. Clinical examinations and audiograms were obtained for all patients by a single-institution Otolaryngology service with comparative data generated from review of pre and post-trauma hearing screens. Follow-up clinical and audiogram data were obtained on all available subjects., Results: 59 TM perforations were documented with audiograms. A conductive hearing loss of 14.8, 22.4, 20.3, and 18.9 dB and sensorineural hearing loss (SNHL) of 18.0, 13.5, 19.9, and 22.0 dB at 500, 1,000, 3,000, and 4,000 Hz, respectively, were observed. 49% of all hearing loss was SNHL. Clinical factors did not correlate statically to hearing loss (p > 0.05). On average, patients demonstrated a 51% improvement in SNHL at time of follow-up., Conclusion: In the subacute setting, patients with traumatic TM perforations secondary to combat blast injury demonstrate both a conductive hearing loss and SNHL, with 49% of all loss being sensorineural. An average SNHL improvement of 51% was seen at follow-up., (Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.)

Mechanical damage to middle ear components in blast exposure directly causes hearing loss, and the rupture of the tympanic membrane (TM) is the most frequent injury of the ear. However, it is unclear how the severity of injury graded by different patterns of TM rupture is related to the overpressure waveforms induced by blast waves. In the present study, the relationship between the TM rupture threshold and the impulse or overpressure waveform has been investigated in chinchillas. Two groups of animals were exposed to blast overpressure simulated in our lab under two conditions: open field and shielded with a stainless steel cup covering the animal head. Auditory brainstem response (ABR) and wideband tympanometry were measured before and after exposure to check the hearing threshold and middle ear function. Results show that waveforms recorded in the shielded case were different from those in the open field and the TM rupture threshold in the shielded case was lower than that in the open field (3.4 ± 0.7 vs. 9.1 ± 1.7 psi or 181 ± 1.6 vs. 190 ± 1.9 dB SPL). The impulse pressure energy spectra analysis of waveforms demonstrates that the shielded waveforms include greater energy at high frequencies than that of the open field waves. Finally, a 3D finite element (FE) model of the chinchilla ear was used to compute the distributions of stress in the TM and the TM displacement with impulse pressure waves. The FE model-derived change of stress in response to pressure loading in the shielded case was substantially faster than that in the open case. This finding provides the biomechanical mechanisms for blast induced TM damage in relation to overpressure waveforms. The TM rupture threshold difference between the open and shielded cases suggests that an acoustic role of helmets may exist, intensifying ear injury during blast exposure., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Objective: To investigate the feasibility of direct application of basic fibroblast growth factor (bFGF) without edge trimming on human subacute traumatic tympanic membrane perforation (TMP)., Methods: A total of 29 patients with traumatic TMPs beyond 1 month after trauma were enrolled. Patients were placed into two groups: an observation group (n=17) and a bFGF-treated group (n=12). The bFGF-treated group was treated by direct application of bFGF, in which the margin of the perforation was not trimmed. All patients were followed at least once per week until the perforation was completely closed or for up to 6 months. The closure rate and closure time were estimated., Results: At 6 months, 11/12 (91.7%) perforations achieved complete closure after bFGF treatment. The mean closure time was 18.1 ± 11.4 days (range=3-65 days). Purulent otorrhea was found after treatment in five patients, but resolved after oral amoxicillin and ofloxacin ear drops. Of these five patients, four achieved complete closure. However, only 9/17 (52.9%) perforations achieved complete spontaneous closure in the observation group. FGF-treated groups had significantly improved closure rates compared to the observation group (91.7% vs. 52.9%, respectively, P=0.03)., Conclusions: Although the margin of the perforation was not trimmed, direct application of bFGF on human subacute TMP was feasible, and it could significantly improve the closure rate of the subacute TMPs. The technique was simple and convenient. Thus, direct application of bFGF should be recommended pre-myringoplasty., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Introduction: Middle ear barotrauma (MEBt) is a frequently occurring complication of hyperbaric oxygen treatment (HBOT). High-grade MEBt may involve tympanic membrane (TM) haemorrhaging. Although many patients undergoing HBOT use antiplatelet or anticoagulant drugs, it is unknown whether these drugs increase the risk of MEBt and particularly TM bleeding complications., Methods: This multicentre, prospective cohort study investigates the prevalence of MEBt and TM bleeding during HBOT in patients using antiplatelet/anticoagulant drugs, compared with control patients not on such medications. MEBt was assessed by video otoscopy of the TM pre and post HBOT and scored according to the modified Teed score. Any complications from previous HBOT sessions were retrospectively documented., Results: Of 73 patients receiving HBOT, 34 used antiplatelet/anticoagulant drugs. Mild MEBt (Teed score 1 or 2) occurred in 23 of these 34 patients and in 31 of the 39 controls. Teed score 3 MEBt occurred in only two of the control-group patients and none of the patients using antiplatelet/anticoagulant drugs. Two patients using anticoagulant drugs reported epistaxis during a previous HBOT session, epistaxis was not reported by any control patients., Conclusion: Low-grade MEBt is common during HBOT, however, high-grade barotrauma is rare with current chamber operating procedures. Patients using antiplatelet/anticoagulant drugs potentially may be prone to MEBt-associated haemorrhagic complications, but we did not observe any such increase in this cohort. Only mild epistaxis occurred in patients using anticoagulant drugs.

Background: The treatment of traumatic tympanic membrane perforations varies in different investigations, ranging from observation to early surgical repair. The present study aimed to focus on the closure rate and the closure time in a group of patients treated with a watchful waiting policy., Methods: The study comprised 133 consecutive patients with a total of 137 perforations. Data were evaluated in terms of aetiology, location and size of perforation, audiometric findings, closure rate, and closure time., Results: The overall closure rate was 97 per cent. For patients with a known closure time within three months, the median closure time was between three and four weeks. The probability of spontaneous closure over time was further analysed with Kaplan-Meier plots, for those perforations with known closure times and for all perforations including those with unknown closure times. Perforation size was the only significant determining factor for closure time., Conclusion: Small perforations had a high probability of spontaneous closure within three to four weeks, justifying a watchful waiting policy. Larger uncomplicated perforations might warrant early surgical repair, depending on the patient's needs and the availability of surgery.