title: Determinants of spontaneous healing in traumatic perforations of the tympanic membrane.
abstract: OBJECTIVE
  To analyse the various factors influencing spontaneous healing of traumatic tympanic membrane perforation in West Africa.
  
  
  METHODS
  Prospective clinical study.
  
  
  METHODS
  Tertiary referral centre.
  
  
  METHODS
  Consecutive patients with traumatic tympanic membrane perforations without history of previous middle ear disease.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Otolaryngology, Federal Medical Center Umuahia, Abia State, Nigeria. tochiorji@yahoo.com
authors.forename: F T
authors.initials: FT
authors.lastname: Orji
authors.forename: C C
authors.initials: CC
authors.lastname: Agu
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009549:Nigeria; D011446:Prospective Studies; D012075:Remission, Spontaneous; D012307:Risk Factors; D013594:Syringes; D018058:Tympanic Membrane Perforation / Q000503:physiopathology*; D014945:Wound Healing / Q000502:physiology*; D014950:Wounds, Penetrating / Q000503:physiopathology; D055815:Young Adult