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.
Humans ; Retrospective Studies ; Tympanic Membrane/injuries* ; Tympanic Membrane Perforation/physiopathology* ; Wound Healing/physiology*

BACKGROUND: In recent years, repair of tympanic membrane(TM) perforation has been investigated using growth promoting factors. Platelet derived growth factor(PDGF), basic 30kD cytokine, promotes wound healing by its mitogenicity for fibroblast and stimulation of the production of fibronectin and hyaluronic acid. OBJECTIVES: The purpose of this study is to investigate the effect of PDGF-AA on the healing process of TM perforation. MATERIALS AND METHODS: The effects of PDGF on the healing process of TM perforation was investigated in rats using the endoscope and light microscope after topical application of 2ug of PDGF-AA or placebo on the edge of TM perforation. The rats were sacrificed at 3, 5, 7, 9, 11, 13 and 15 days following the surgery of TM. The tympanic membranes were also immunohistochemically examined for PDGF-Ralpha and fibronectin to evaluate the mechanism of healing process in the PDGF-treated-TM. RESULTS: 1) Application of PDGF-AA accelerated the healing process of TM perforation and the wound was completely closed at 5 days following surgery. 2) PDGF-AA induced prominent proliferation of the connective tissue layer of TM after surgery, however the connective tissue growth has reduced at 2 weeks following surgery. 3) PDGF-Ralpha was intensely expressed in the epithelial layer of the PDGF-AA-treated TM. 4) Intense expression of fibronectin was observed in the fibroblasts of the connective tissue layer of the PDGF-AA-treated TM. CONCLUSION: From this study, we concluded that PDGF may play a role in the imm-unoregulation of the healing process of TM perforation and it may be an alternative to the surgical management of TM perforation.
Animals ; Blood Platelets ; Connective Tissue ; Endoscopes ; Fibroblasts ; Fibronectins* ; Hyaluronic Acid ; Rats ; Tympanic Membrane Perforation* ; Tympanic Membrane* ; Wound Healing ; Wounds and Injuries

Epidermal Growth Factor ; therapeutic use ; Humans ; Recombinant Proteins ; therapeutic use ; Tympanic Membrane ; injuries ; Tympanic Membrane Perforation ; drug therapy

OBJECTIVETo explore the protective effects of earplug and barrel on auditory organs of guinea pigs exposed to experimental blast underpressure (BUP).

METHODSThe hearing thresholds of the guinea pigs were assessed with auditory brainstem responses (ABR). The traumatic levels of tympanic membrane and ossicular chain were observed under stereo-microscope. The rate of outer hair cells (OHCs) loss was analyzed using a light microscope. The changes of guinea pigs protected with barrel and earplug were compared with those of the control group without any protection.

RESULTSAn important ABR threshold shift of the guinea pigs without any protection was detected from 8h to 14d after being exposed to BUP with a peak ranging from -64.5 kPa to -69.3 kPa ( P<0.01). The rate of perforation of tympanic membrane reached 87.5% and that of total OHCs loss was 19.46% +/- 5.38% at 14d after exposure. The guinea pigs protected with barrel and earplug had lower ABR threshold and total OHCs loss rate compared with the animals without any protection (P<0.01). All of the tympanic membrane and ossicular chain of the protected animals maintained their integrities. Meanwhile, the guinea pigs protected with the barrel had lower ABR threshold and total OHCs loss rate than those with earplug (P<0.01).

CONCLUSIONSThe earplug and barrel have protective effects against BUP-induced trauma on auditory organs of the guinea pigs and the protective effects of barrel are better than those of earplug.

Animals ; Auditory Threshold ; Blast Injuries ; prevention & control ; Ear Protective Devices ; Guinea Pigs ; Hair Cells, Auditory, Outer ; metabolism ; Pressure ; Tympanic Membrane ; injuries ; Tympanic Membrane Perforation ; etiology ; physiopathology ; prevention & control

Blast injuries are increasing worldwide from combat and explosions in heavy industry. Primary blast injury is direct injury due to the high pressure effects and pressure differentials of the blast wave itself. Alternating overpressure and underpressure imposed upon tissues of heterogenous densities, particularly air-filled organs. The ear is the first affected organ to primary blast injury because it is the body's most sensitive pressure transducer. Otologic blast injury and tympanic membrane perforation have traditionally been used as a predictor, or biomarker, of occult serious primary blast injury. Hearing loss and tinnitus are the most common ear symptoms. This review details the otologic consequences of blast exposure.
Blast Injuries ; Ear ; Explosions ; Hearing ; Hearing Loss ; Metallurgy ; Tinnitus ; Transducers, Pressure ; Tympanic Membrane Perforation

BACKGROUND AND OBJECTIVES: Traumatic tympanic membrane (TM) perforatons are encountered relatively often in clinical practice. We carried out a retrospective study of TM perforation according to different injury types, age and sex distribution, and relationship between size of perforation, degree of hearing loss and duration of spontaneous healing. MATERIALS AND METHODS: A retrospective review was performed on 152 cases of traumatic TM perforation diagnosed in the emergency room from January, 1992 to December, 1997. RESULTS: There was follow up loss in 109 out of 152 cases. Its incidence was predominant in males, acounting for the ratio of male to female being about 2:1. Injury to the left side was predominant, there being 112 cases (79%), compared to 40 cases (31%) to the right side. Perforation of Grade I was most common, with 86 cases (57%). Among them, with 54 cases (35.5%), antero-inferior perforation constituted about one third of all cases. The mean air-conduction difference was 14.7dB, and showed a tendency to increase as the size of perforation increased. Spontaneous healing rate was 76%, and the mean duration for complete healing was 22.1 days. There was also a tendency for the duration of healing to increase as the size of perforation increased. In the case of complication with otorrhea, there was a tendency for the duration of healing to be shorter. CONCLUSION: Although traumatic TM perforations have good prognosis, it is necessary to induce patients with profuse explanations for possible complications to visit the out-patient clinic until the wound has healed completely.
Emergency Service, Hospital ; Female ; Follow-Up Studies ; Hearing Loss ; Humans ; Incidence ; Male ; Outpatients ; Prognosis ; Retrospective Studies ; Sex Distribution ; Tympanic Membrane Perforation* ; Tympanic Membrane* ; Wounds and Injuries

OBJECTIVE: To explore the clinical treatment effects of sea buckthorn oil for in different size traumatic perforation of tympanic membrane in different size. METHOD: Prospective, randomized study of 199 outpatients with traumatic perforation of tympanic membrane who were enrolled between December 2012 and December 2014 after informed consent. The patients were divided into treatment group (101 cases) and control group (98 cases). According to the size of the perforations, patients in each group were divided into large perforation group, middle perforation groups and small perforation group. The cases in large perforation group, middle perforation groups and small perforation group were 36, 34, 31 in treatment group and 35, 33, 30 in control group. The patients in treatment group were treated with sea buckthorn oil once a week, while the patient in control group were self-healing and checked once a week. All the patients were followed-up in two months. The healing rate of two groups was applied for the evaluation indicator of clinical effect. We compared the healing rate, average healing time and phological change of tympanic membrane of patients at the first and second month. RESULT: The total healing ratio of patients in treatment group is 62.4% and 79.2% compared with 29.6% and 57.1% in control group at the first and second month (P < 0.05). There is statistical significance between the healing ratios of middle, large perforation groups in treatment group and control group (P < 0.05). There is no statistical significance between the healing ratios of small perforation group in treatment group and control group (P > 0.05). The average healing time of large, middle and small perforation group at the second month are significantly shorter than the control group. CONCLUSION It is better to apply observation method and let it self-healed for small traumatic tympanic membrane perforation according to its higher healing ratio. While, it is better to apply sea buckthorn oil method for middle and large traumatic tympanic membrane perforation according to its lower healing ratios. Sea buckthorn oil treatment is benefitial for increasing the ratio of perforation healing, shorten the healing time, resumpting of the middle ear function earlier, helping most of the patients to avoid operation and the reduce medical expense. Therefore, it is valuable to promote the method in clinical treatment.
Drugs, Chinese Herbal ; therapeutic use ; Hippophae ; Humans ; Plant Oils ; therapeutic use ; Prospective Studies ; Tympanic Membrane ; injuries ; Tympanic Membrane Perforation ; drug therapy ; Wound Healing ; drug effects

220 cases of tympani membrane perforated were summarized retrospectively. The tympani membrane perforated of injury was different from otitis media's because they had marked or extreme marked difference in sex, age, ear distinction, shape, position, size, degree of hearing damaged, time of healing, cause of perforating and adhesive substance. This difference was relative to mechanism of tympani membrane perforated. The distinction gist of two sorts of tympani membrane perforated was expounded through comparison and analysis. It would be of great value to clinical forensic medical examination.
Adolescent ; Adult ; Aged ; Child ; Diagnosis, Differential ; Female ; Forensic Medicine ; Humans ; Male ; Middle Aged ; Otitis Media/complications* ; Retrospective Studies ; Tympanic Membrane/injuries* ; Tympanic Membrane Perforation/etiology*

The incidence of blast injury has increased recently. As the ear is the organ most sensitive to blast overpressure, the most frequent injuries seen after blast exposure are those affecting the ear. Blast overpressure affecting the ear results in sensorineural hearing loss, which is untreatable and often associated with a decline in the quality of life. Here, we review recent cases of blast-induced hearing dysfunction. The tympanic membrane is particularly sensitive to blast pressure waves, since such waves exert forces mainly at air-tissue interfaces within the body. However, treatment of tympanic membrane perforation caused by blast exposure is more difficult than that caused by other etiologies. Sensorineural hearing dysfunction after blast exposure is caused mainly by stereociliary bundle disruption on the outer hair cells. Also, a reduction in the numbers of synaptic ribbons in the inner hair cells and spiral ganglion cells is associated with hidden hearing loss, which is strongly associated with tinnitus or hyperacusis.
Blast Injuries/complications* ; Ear/injuries* ; Hearing Loss, Conductive/etiology* ; Hearing Loss, Sensorineural/etiology* ; Humans ; Tympanic Membrane Perforation/complications*

The main objective of this study is to provide an overview of the basic mechanisms of blast induced hearing loss and review pharmacological treatments or interventions that can reduce or inhibit blast induced hearing loss. The mechanisms of blast induced hearing loss have been studied in experimental animal models mimicking features of damage or injury seen in human. Blast induced hearing loss is characterized by perforation and rupture of the tympanic membrane, ossicular damage, basilar membrane damage, inner and outer hair cell loss, rupture of round window, changes in chemical components of cochlear fluid, vasospasm, ischemia, oxidative stress, excitotoxicity, hematoma, and hemorrhage in both animals and humans. These histopathological consequences of blast exposure can induce hearing loss, tinnitus, dizziness, and headache. The pharmacological approaches to block or inhibit some of the auditory pathological consequences caused by blast exposure have been developed with antioxidant drugs such as 2,4-disulfonyl alpha-phenyl tertiary butyl nitrone (HXY-059, now called HPN-07) and N-acetylcysteine (NAC). A combination of antioxidant drugs (HPN-07 and NAC) was administered to reduce blast induced cochlear damage and hearing loss. The combination of the antioxidant drugs can prevent or treat blast induced hearing loss by reducing damage to the mechanical and neural component of the auditory system. Although information of the underlying mechanisms and treatment of blast induced hearing loss are provided, further and deep research should be achieved due to the limited and controversial knowledge.
Acetylcysteine ; Animals ; Basilar Membrane ; Blast Injuries ; Dizziness ; Hair ; Headache ; Hearing ; Hearing Loss ; Hematoma ; Hemorrhage ; Humans ; Ischemia ; Models, Animal ; Oxidative Stress ; Rupture ; Tinnitus ; Tympanic Membrane