Educational visual regarding tympanic membrane perforation (TMP) and epithelialization, featuring clinical imaging and histology. Panel (a) is an otoscopic/microscopic clinical photograph showing a clear, oval-shaped perforation in the tympanic membrane (TM). The middle ear (ME) is visible through the defect. The margins of the perforation are distinct and rounded, demonstrating characteristic epithelialization. Panel (b) presents a high-magnification histology section stained with Hematoxylin and Eosin (H&E), showing the TM cross-section at the perforation edge. It illustrates the overgrowth of keratinizing squamous epithelium from the external auditory canal (EAC) side, curling around the defect margin toward the middle ear (ME) surface. A black arrow indicates the direction of epithelial migration, which inhibits spontaneous closure by creating a continuous skin layer over the wound edge. This composite serves as a diagnostic and pathological reference for chronic tympanic membrane defects and wound healing failure in otolaryngology.

This composite of clinical endoscopic photographs illustrates a comparative study of the right ear canal and epithelial migration. Image A shows the pre-operative ear canal, characterized by the presence of cerumen or pathological debris (dark brown/black mass) obstructing the view of the tympanic membrane. Image B displays the post-operative state, showing a clearer canal with surgical changes and a visible ink marker used for tracking. Image C demonstrates the epithelial migration pattern in a posterior-superior direction, evidenced by the movement of dark ink markings (indicated by a white arrow) along the canal wall. The series serves to educate on otologic surgical outcomes and the physiological process of epithelial self-cleansing in the external auditory canal. Key concepts include postoperative monitoring of ear canal health and the quantification of migration rates (linear movement measured in mm/week) to assess physiological recovery.

This series of six otoendoscopic images (a–f) illustrates the chronological stages of spontaneous tympanic membrane healing over a 49-day period. The initial images (a, b) show a traumatic eardrum perforation bisected by an 'eardrum bridge' (white arrow), which is a strip of intact tissue spanning the defect. Subsequent frames (c–e) document the process of stratified epithelial migration. Proliferating epithelium at the perforation margins (black arrows) is seen moving centripetally to close the gap. During this progression, the eardrum bridge serves as a scaffold; it gradually incorporates into the regenerating tissue or is replaced by newly formed epithelium. By day 49 (f), the perforation has achieved complete closure, the eardrum bridge is no longer a distinct structure, and the tympanic membrane shows a restored, uniform surface with minor residual scarring. This series demonstrates key concepts in otolaryngology, specifically the natural history of traumatic perforation repair and the role of epithelial hyperplasia in secondary intention healing of the tympanic membrane.