Tympanic Membrane Perforation Tympanic Membrane Perforation • Tympanic membrane perforation after removal of tympanostomy ventilation tube. Definition
• A hole or tear in the eardrum(s) • Usually results from disease, trauma, or iatrogenic causes • Infection is the major cause of tympanic membrane perforation (TMP) • Perforation can be temporary or permanent (most perforations heal completely on their own) • Symptoms of perforation varies with size and location on the ear drum Signs and Symptoms
• Ear pain that subside quickly • Otorrhea • Hearing loss • Tinnitus • Vertigo • Audible whistling sounds during sneezing and nose blowing • Frequent infection during colds or with water in the ear canal Causes
• Middle ear infection (most common)
• Barotrauma
• Acoustic trauma
• Physical trauma to the tympanic membrane
• Severe head trauma Otoscopic Appearance
http://sydneyentclinic.com/sean-flanagan/wp- http://www.entbristol.co.uk/wp- content/uploads/2010/06/central_perforation.jpg content/uploads/2015/07/otoscopy_29.png Tympanic Membrane Perforation Otoscopy Appearance: Examination of right ear shows a clear canal leading to a perforated tympanic membrane. The drum is intact posteriorly up to the border of the malleus. Anterior (right of picture) to the malleus there is a large perforation extending from the superior to inferior borders of the annulus. The intact drum appears sclerotic. The middle ear is dry. R6 Diagnosis General •Clinical diagnosis with otoscopy examination •Otomicroscopy can identify small perforation. •Middle ear impedance testing •Screening tympanometry may reveal abnormalities consistent with perforation •Audiometry upon initial TMP diagnosis and before any repair attempt
• Imaging usually not indicated Treatment
• Most traumatic TM perforations heal spontaneously • OK to watch and wait • Recommend dry ear precautions to prevent ear infection • Non-surgical in-office Treatments: eardrum paper patch • Surgery- Tympanoplasty (usually recommended after the age of 7) 2 reasons to do surgery: 1. Provide dry and safe ear 2. Restore hearing Complications
• Hearing loss