First letter
Dear Editors,
We would like to address the manuscript titled ‘Evaluation and comparison of type I tympanoplasty efficacy and histopathological changes to the tympanic membrane in dry and wet ear: a prospective study’ by Shankar et al.Reference Shankar, Virk, Gupta, Gupta, Bal and Bansal1
Their work is excellent and expands the indications for myringoplasty for chronic tympanic membrane perforation, and should shorten the waiting time for surgery in patients with a chronic tympanic membrane perforation. However, we believe that two points need to be clarified.
First, the inclusion criteria included patients with history of discharge for at least six weeks, but the authors did not describe the degree or properties of the discharge in detail. Some studies have shown that a moist middle-ear condition without purulent discharge does not affect eardrum healing; in fact, it can accelerate eardrum healing.Reference Lou, Tang and Xiao2–Reference Caylan, Titiz, Falcioni, De Donato, Russo and Taibah6 In comparison, an excessively wet environment adversely affects eardrum healing, especially in patients with purulent discharge.Reference Griffin7 Studies have suggested that excess moisture in the wound bed impairs the healing process, leading to peri-wound maceration.Reference Schultz, Sibbald, Falanga, Ayello, Dowsett and Harding8, Reference Dowsett and Ayello9 If the excess moisture is left unchecked, healing can be impeded, and there may be subsequent breakdown and further deterioration of the wound bed. Therefore, we believe that the authors should clearly describe the degree and properties of the discharge to help the reader select patients.
Second, the authors did not describe in the Methods section of the article whether the sclerotic plaques on the residual eardrum need to be removed. The sclerotic plaques associated with chronic tympanic membrane perforation are an important factor affecting eardrum healing. Some studies of tympanoplasty for chronic tympanic membrane perforation found that excision of the sclerotic plaques improved the success rate.Reference Migirov and Volkov10, Reference Aslan, Katilmiş, Oztürkcan, Ilknur and Başoğlu11 In addition, two studies of fibroblast growth factor-2 for traumatic and chronic tympanic membrane perforation proved that residual tympanic membrane calcification was a significant risk factor for non-healing of tympanic membrane perforation.Reference Hakuba, Hato, Okada, Mise and Gyo12, Reference Lou, Yang, Tang and Xiao13 The authors of a study of spontaneous healing in a large sample of traumatic tympanic membrane perforation cases suggested that pre-existing sclerotic plaques were the main cause of healing failure.Reference Lou, Tang and Yang4 Therefore, the paper would have been better if it had compared the success rates among tympanic membrane perforation patients with and without sclerotic plaque.
