Tympanoplasty after war blast lesions of the eardrum: retrospective study

To establish whether hearing loss after eardrum blast injury could be recovered by tympanoplasty performed immediately after injury and what material is the most suitable for eardrum closure. Tympanoplasty was performed in 119 (a total of 181 injuries) out of 651 patients examined for blast injury of the ear between 1991 and 2000. The study included a total of 106 patients who underwent tympanoplasty: 51 patients with unilateral and 55 with bilateral blast eardrum rupture (a total of 161 injuries). Three different materials were used for eardrum rupture closure: temporal fascia in 81, perichondrium in 61, and heterograft in 19 cases. Injuries were divided in 4 groups, according to the time elapsed between the injury and tympanoplasty (0-20, 21-60, 61-180, and 181 days and more). Otomicroscopic finding, audiometry, and tympanometry were used for definitive evaluation of tympanoplasty outcome. Eardrum rupture was successfully closed with temporal fascia in 91%, perichondrium in 92%, and heterograft in 89% of the cases (p=0.429). There were no statistically significant differences in either values of postoperative air- bone gap (p=0.210) or in eardrum perforation closure rate (p=0.951) with respect to the time period between the injury and tympanoplasty. Also, there was no correlation between the postoperative air-bone gap and the number of days elapsed between the rupture and tympanoplasty (r=-0.037, p=0.641). Small ruptures of the eardrum should be left to heal spontaneously. The patients with subtotal and total rupture and rupture that did not heal spontaneously in three months should undergo tympanoplasty. Temporal fascia, perichondrium from tragus, and heterograft are equally acceptable materials for eardrum closure after blast injury.