myringoplasty after traumatic perforation

[Neuropathia]

How long do you wait after a traumatic perforation of the tympanic membrane before you schedule surgery?
I only ever see fresh perforations on my night shifts. I put a patch on, put a tamponade in the ear canal and always send them home and tell them to see their local ENT for a follow up. I know the majority of perforations close spontaneously, but since I don't do the follow up myself I have no personal experience.
I recently saw a perforation that was about 75% of the membrane and I wondered if it would still close by itself.

Thanks for the answers and sorry for the stupid question

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[Pir8DeacDoc]

At least in my mind (resident), the time frame probably doesn't exist as a strict number (i.e at three months we're gonna fix it). It would depend on the trajectory of healing from the initial evaluation and what other symptoms the person might be having. If they have excellent hearing, no drainage, and a monomeric layer forming over the TM then we can safely let that have a few months or more to try and heal. If the hearing is down and the ear is draining (or the patient not compliant with water precautions) then that might push towards a repair sooner. Other considerations would be what type of repair you anticipate. If it's just a fat graft then maybe worth a shot sooner . If the patient will require a formal tympanoplasty, then maybe worth more waiting. No strict answers, just close follow up and a frank discussion with the patient about their wishes.

 

[resxn]

At least in my mind (resident), the time frame probably doesn't exist as a strict number (i.e at three months we're gonna fix it). It would depend on the trajectory of healing from the initial evaluation and what other symptoms the person might be having. If they have excellent hearing, no drainage, and a monomeric layer forming over the TM then we can safely let that have a few months or more to try and heal. If the hearing is down and the ear is draining (or the patient not compliant with water precautions) then that might push towards a repair sooner. Other considerations would be what type of repair you anticipate. If it's just a fat graft then maybe worth a shot sooner . If the patient will require a formal tympanoplasty, then maybe worth more waiting. No strict answers, just close follow up and a frank discussion with the patient about their wishes.

Agree. I think the rule of thumb is that 90% close within 6 weeks, 75% close within 3 weeks. If I get a call from a PCP or the ED, I'll have the pt come in at 3 weeks and if not normal, then at 6. Based on how they're doing decide on observation, myringoplasty, or tympanoplasty.

 

[Neuropathia]

Thanks for your answers.👍
Do you leave anything on the perforation (tamponade?) for the entire time or let it just heal by itself?

 

[resxn]

I don't leave anything on a traumatic perforation as the vast majority heal on their own.