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Case study of a hydrostatic pressure-induced traumatic chronic tympanic membrane perforation with purulent otorrhea and spontaneous closure

Tympanic membrane (TM) perforations are ruptures of the membrane separating the middle and outer ear which heal spontaneously in 78.7-94% of cases. However, with large perforations and infection, the spontaneous closure rate diminishes.Chronic TM perforations are thought to rarely close spontaneously and are often treated with a myringoplasty which has a variable success rate, potential risks, and a significant recovery period during which patient activity is notably limited. Significant controversy exists over the indication for surgical intervention in the case of grade 3, chronic TM perforation with a history of infection. The aim of this case study is to provide insight into the typical progression and potential spontaneous resolution of such cases. Moreover, there is a lack of publicly available reference images outlining the progress of TM perforation healing, so detailed time-stamped photos are included. The investigators imaged, at regular intervals, a 23-year-old male’s mid-anterior chronic grade 3 TM perforation who presented with an outer and middle ear infection with purulent otorrhea. The result indicates that chronic grade 3 TM perforations with a history of infection still have potential to spontaneously close. Given the risks and inconvenience of a myringoplasty, further consideration should be taken before recommending this procedure in these cases.