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Tympanic membrane perforations: a critical analysis of 1003 ears and proposal of a new classification based on pathogenesis

  • Otology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

To present a large series ears with tympanic membrane perforations (TMP), to describe their characteristics, and to propose a new classification system based on the pathogenesis of TMP.

Methods

This cross-sectional study was conducted at a tertiary university hospital with 1003 ears (792 consecutive patients with TMP in at least 1 ear). Otoendoscopy and audiometry were performed. Perforation measurements and their locations were digitally assessed. TMP with no suggestive signs of previous retraction were classified as Group 1, and those with possible previous retraction were classified as Group 2. Signs of retraction previous to the TMP, symptom length, perforation size and location, status of the contralateral ear, and hearing status were compared.

Results

Group 1 comprised 63.5% of the included ears. Compared to Group 2, Group 1 presented a higher rate of central perforations (99% vs. 53%), a shorter duration of symptoms, smaller perforations (mean area: 18.5% vs. 41.4%), a higher rate of perforations in the anterior quadrants, better hearing levels (mean tritonal gap: 23.9 dB vs. 29.2 dB), and a lower rate of abnormal contralateral ears (28% vs. 66%).

Conclusion

The classification of TMP into two groups based on signs of previous retractions is feasible and indicates two different levels of disease severity. While the group without previous signs of retraction comprises ears with more limited disease, membranes with previous retraction seem to show more severe disease and, consequently, a less functional middle ear.

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Availability of data and materials

All the data of this study are available from the first author, who can be reached by email and at the address provided above. All the data are stored at the Hospital de Clínicas de Porto Alegre (Zona 19).

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Funding

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Authors and Affiliations

  1. Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço (Zona 19), Hospital de Clínicas de Porto Alegre, Av. Ramiro Barcelos 2350, Porto Alegre, Rio Grande Do Sul, 90035-903, Brazil

    Fábio André Selaimen, Leticia Petersen Schmidt Rosito, Mauricio Noschang Lopes da Silva & Sady Selaimen da Costa

  2. Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil

    Fábio André Selaimen, Leticia Petersen Schmidt Rosito, Mauricio Noschang Lopes da Silva & Sady Selaimen da Costa

  3. Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil

    Valentina de Souza Stanham

  4. Weill Cornell Medical College, New York, NY, USA

    Neil Sperling

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  1. Fábio André Selaimen
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  2. Leticia Petersen Schmidt Rosito
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  3. Mauricio Noschang Lopes da Silva
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Correspondence to Fábio André Selaimen.

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The present study was performed in accordance with the ethical standards approved by the Research and Graduate Group of our institution (protocol #3.222.820).

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Selaimen, F.A., Rosito, L.P.S., da Silva, M.N.L. et al. Tympanic membrane perforations: a critical analysis of 1003 ears and proposal of a new classification based on pathogenesis. Eur Arch Otorhinolaryngol 279, 1277–1283 (2022). https://doi.org/10.1007/s00405-021-06776-8

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  • DOI: https://doi.org/10.1007/s00405-021-06776-8

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