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Spontaneous closure of traumatic tympanic membrane perforations: observational study

Published online by Cambridge University Press:  06 November 2015

Z C Lou*
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Affiliated Yiwu Hospital of Wenzhou Medical University, Yiwu City, China
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Abstract

Type
Letters to the Editors
Copyright
Copyright © JLO (1984) Limited 2015 

Dear Editors,

I would like to address the article titled ‘Spontaneous closure of traumatic tympanic membrane perforations: observational study’ by Jellinge et al.Reference Jellinge, Kristensen and Larsen1

Their work is very important. I agree with the authors in that traumatic tympanic membrane perforation has the highest closure rate with spontaneous healing. Regarding inverted and everted edges, however, the authors cited my paper and wrote, ‘Previous reports of the importance of inverted and everted edges are contradictory,Reference Lou, Tang and Yang2, Reference Lou3 but it has been stated that the type of epithelial migration has importance for closure time but not for closure rate’.Reference Lou3

I feel that Jellinge et al. misunderstand the two concepts of inverted edge and outward epithelial migration, which resulted in a misquotation. Inverted and everted edges refer to the remaining residual eardrum at the perforation margin when tympanic membrane perforation occurred, and the edge comprises the three layers of the eardrum. Studies have suggested that an inverted edge may migrate inward into the middle tympanic cavity, which results in failure to heal, or the development of a middle-ear cholesteatoma.Reference Armstrong4Reference Winerman, Man and Segal6 Our study suggested that the inverted and everted edges gradually become necrotic, form a crust, and migrate into the external auditory canal. Consequently, an inverted edge does not affect the outcome of spontaneous healing.Reference Lou and He7 Other studies obtained similar findings.Reference Park, Kim, Lee and Lee8Reference Camnitz and Bost10 By contrast, outward migratory epithelium is the outer squamous epithelial layer of the tympanic membrane on the perforation edge that proliferates and migrates upward away from the centre of the perforation during the spontaneous healing process. This non-centripetal migration of proliferating epithelial cellsReference Lou3 may occur in perforations with and without inverted edges. It is merely an abnormal or pathological epithelium migration that occurs during the healing of traumatic tympanic membrane perforation, not another means of eardrum healing.

Our study showed that the perforation can start to heal only when the outward epithelial migration pattern evolves into a centripetal migration pattern. Once outward epithelial migration occurs, it may prolong and impede the closure of traumatic eardrum perforation.Reference Lou3

Based on these studies, I realise that the description of the quote in their Discussion confused inverted edge and outward migratory epithelium.

References

1Jellinge, ME, Kristensen, S, Larsen, K.Spontaneous closure of traumatic tympanic membrane perforations: observational study. J Laryngol Otol 2015;129:950–4CrossRefGoogle ScholarPubMed
2Lou, ZC, Tang, YM, Yang, J.A prospective study evaluating spontaneous healing of aetiology, size and type-different groups of traumatic tympanic membrane perforation. Clin Otolaryngol 2011;36:450–60CrossRefGoogle ScholarPubMed
3Lou, ZC.Spontaneous healing of traumatic eardrum perforation: outward epithelial cell migration and clinical outcome. Otolaryngol Head Neck Surg 2012;147:1114–19CrossRefGoogle ScholarPubMed
4Armstrong, B.Traumatic perforations of the tympanic membrane: observe or repair? Laryngoscope 1972;82:1822–30CrossRefGoogle ScholarPubMed
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8Park, MK, Kim, KH, Lee, JD, Lee, BD.Repair of large traumatic tympanic membrane perforation with a Steri-Strips patch. Otolaryngol Head Neck Surg 2011;145:581–5CrossRefGoogle ScholarPubMed
9Jun, HJ, Oh, KH, Yoo, J, Han, WG, Chang, J, Jung, HH et al. A new patch material for tympanic membrane perforation by trauma: the membrane of a hen egg shell. Acta Otolaryngol 2014;134:250–4CrossRefGoogle ScholarPubMed
10Camnitz, PS, Bost, WS.Traumatic perforations of the tympanic membrane: early closure with paper tape patching. Otolaryngol Head Neck Surg 1985;93:220–3CrossRefGoogle ScholarPubMed