A perforated eardrum ( tympanic membrane perforation) is a prick in the eardrum. It can be caused by infection (otitis media), physical trauma, overpressure (loud noise), inappropriate ear clearing, and changes in middle ear pressure. An otoscope can be used to view the eardrum to diagnose a perforation. Perforations may heal naturally or require surgery.
Presentation
A perforated eardrum leads to conductive hearing loss, which is usually temporary. Other symptoms may include
tinnitus,
ear pain,
vertigo, or a discharge of
mucus.
and/or
vomiting secondary to vertigo may occur.
Causes
A perforated eardrum can have one of many causes, such as:
Diagnosis
An
otoscope can be used to look at the
ear canal. This gives a view of the
ear canal and
eardrum, so that a perforated eardrum can be seen.
Tympanometry may also be used.
Treatment
Conservative management
A perforated eardrum often heals naturally.
It may heal in a few weeks or may take up to a few months.
Surgery
Some perforations require surgical intervention.
This may take the form of a paper patch to promote healing (a simple procedure by an ear, nose and throat specialist), or surgery (
tympanoplasty).
However, in some cases, the perforation can last several years and will be unable to heal naturally. For patients with persistent perforation, surgery is usually undertaken to close the perforation. The objective of the surgery is to provide a platform of sort to support the regrowth and healing of the tympanic membrane in the two weeks post-surgery period. There are two ways of doing the surgery:
-
Traditional tympanoplasty, usually using the microscope and performed through a 10 cm incision behind the ear lobe. This technique was introduced by Wullstien and Zollner
-
Endoscopic tympanoplasty, usually using the endoscope through the ear canal without the need for incision. This technique was introduced and popularized by Professor Tarabichi of TSESI: Tarabichi Stammberger Ear and Sinus Institute.
The success of surgery is variable based on the cause of perforation and the technique being used. Predictors of success include traumatic perforation, dry ear, and central perforations. Predictors of failure includes young age and poor Eustachian tube function.
External links
