Tympanic membrane perforations from water sports: treatment and outcome

A Systematic Review of Nonautologous Graft Materials Used in Human Tympanoplasty

OBJECTIVES

Nonautologous graft materials may solve several dilemmas in tympanoplasty by obviating the need for graft harvest, facilitating consistent wound healing, and permitting graft placement in the clinical setting. Prior studies of nonautologous grafts in humans have shown variable outcomes. In this systematic review, we aim to 1) summarize clinical outcomes and 2) discuss limitations in the literature regarding nonautologous grafts for tympanoplasty in humans.

METHODS

A literature review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. The study size, etiology and duration of perforation, type of nonautologous graft, and postoperative closure rate were assessed.

RESULTS

The PRISMA approach yielded 61 articles, including 3,247 ears that met inclusion criteria. Studies evaluated nonautologous grafts including paper patch, gelatin sponge, growth factors, porcine small-intestinal submucosa, among others. Traumatic perforations (62.3%) were most commonly studied, whereas postinfectious perforations (31.9%) and other etiologies (5.8%) comprised a minority of cases. Acute perforations of <8 weeks duration constituted just over half of all treated ears. Overall closure rate was 82.1%, with significantly higher closure rates in acute (89.9%) versus chronic perforations (64.9%, P < .01), regardless of material. A median postoperative air-bone gap of 5.6 dB was found in the 23% of studies reporting this metric.

CONCLUSIONS

The majority of publications reviewing nonautologous materials in tympanoplasty evaluate acute or traumatic perforations, and few rigorously report hearing outcomes. Given available data, porcine submucosa and basic fibroblast growth factor may hold promise for chronic perforation closure. Future studies should report closure rates and hearing outcomes in perforations >8 weeks duration. Laryngoscope, 131:392-400, 2021.

Water Polo Injuries and Training Methods

Water polo is a unique team sport combining swimming sprints and eggbeater kicking, frequent overhead movements and throwing, and regular physical contact with minimal protective equipment. Accordingly, a wide variety of training methods attempt to enhance all of these skill sets. This usually includes some combination of aerobic/anaerobic fitness (via swimming), sport-specific skills, strengthening, and nutrition. In addition, injuries in water polo are somewhat diverse. Physical contact is responsible for the majority of acute injuries, most frequently being injuries to the head and face. The high prevalence of shoulder pain in water polo is likely related to increased shoulder mobility and subsequent instability and stress on shoulder structures, yet the underlying causation is not certain. The unique aspect of shoulder injuries occurring in water polo players is that they may be due to a combination of swimming-related overuse conditions, overhead throwing, and acute trauma-related conditions. Although there is generally minimal evidence-based information available, this article attempts to highlight the current knowledge that we have in regard to water polo injuries and training methods.

Hydroscopic properties of organic objects that may present as aural foreign bodies

Background

Organic foreign bodies swell when irrigated with water, potentially making extraction more difficult. As the degree and rate of swelling of different types of organic foreign bodies has not been established, we aimed to analyze the hydroscopic properties of different organic foreign bodies in body temperature water.

Methods

Dry kidney beans, brown beans, peas, popcorn kernels, and dried fruits were soaked in a body temperature (37^oC) water bath. Volume of these organic materials was measured hourly to 8 hours, then at 12, 16, 24, 28, 36 and 48 hours.

Results

All dried fruits and beans increased in volume over time. The volume increase from baseline at 6 hours was between 43% (popcorn kernels) and 383% (kidney beans). Peas, popcorn, and raisins did not increase volume further after 6 hours. Kidney and brown beans had the greatest increase in volume overall (1268% and 482% respectively), and the greatest continued increase after 24 hours.

Conclusions

Many organic substances that frequently present as aural foreign bodies may swell enough in water to lodge tightly in the ear canal. Typical popcorn kernels and dried peas will not swell sufficiently to lodge tightly in the ear canal of a typical child one year or older. A retained organic foreign body in a moist ear canal may cause inflammation until the foreign body can be removed. These risks may be offset by the advantages of successful removal with irrigation.

Keywords

Foreign body; Irrigation; Organic; Ear; Hydroscopic; Procedure; Removal

Extended high-frequency audiometry in traumatic tympanic membrane perforations

Air- and bone-conduction audiometry in the frequency ranges 0.125-18 kHz and 0.25-16 kHz respectively were performed in 38 patients with unilateral traumatic tympanic membrane perforation. Sensorineural threshold elevation was found in 16 ears. In nine of these this was permanent and in four restricted to the frequency range > 8 kHz. Both sensorineural threshold elevation and tinnitus (n = 16) diminished with time. A temporary, mean 5 dB, bone-conduction threshold elevation > or = 8 kHz was seen in 26 ears before spontaneous tympanic membrane closure. Closure resulted in a 7-20 dB improvement of air-conduction thresholds in the 0.125-18 kHz range, somewhat less in the upper than in the lower frequencies. A 3 dB mean final conductive hearing loss > 8 kHz was found in these 26 ears approximately 5 months after injury, probably due to scars in the pars tensa at the site of the former perforations. Thirty-seven of 38 perforations had healed at final follow-up examination.

Spontaneous healing of traumatic tympanic membrane perforations in man: a century of experience

Widespread controversy exists concerning the treatment of traumatic tympanic membrane perforations. To elucidate the issue, a reference value for the rate of spontaneous tympanic membrane closure in man, to which the healing rates following different techniques of early surgical repair should be compared, was established on the basis of a review of more than 500 texts covering a century's literature on the traumatically perforated tympanic membrane. The spontaneous healing rate appeared to be close to 80 (78.7 per cent) in 760 evaluable cases of traumatic tympanic membrane perforations of all sorts diagnosed within 14 days post injury. A relative, causal-related variation of spontaneous healing could be demonstrated, and a pathogenetic classification of direct traumatic tympanic membrane perforations into ruptures induced by air-pressure changes, heat or corrosives, solids, and water pressures, is of proved clinical value and may have medico-legal validity. There is an obvious need for clinically controlled studies on the spontaneous healing of all kinds of traumatic perforations of the tympanic membrane in humans, and important elements in the design of future studies are advocated.