Makindo Medical Notes

Related Subjects: |Assessing Hearing Loss |Benign Paroxysmal Positional Vertigo (BPPV) |Cholesteatoma |Epistaxis (Nosebleeds) |Acute Mastoiditis |Nasal polyps |Acute Sinusitis |Sudden Sensorineural Hearing loss (SNHL) |Causes of Vertigo |Tympanic (Eardrum) membrane perforation

A tympanic membrane perforation, also known as an eardrum rupture, occurs when there is a tear or hole in the thin tissue (tympanic membrane) that separates the ear canal from the middle ear. This condition can result in hearing loss, discomfort, and increased vulnerability to infections. Tympanic membrane perforations can be caused by infections, trauma, or sudden changes in pressure.

About

• Perforated ear drum. Avoid getting water in the ear

Causes

• Infections:
  • Acute Otitis Media: A middle ear infection can cause pus to build up behind the eardrum, leading to increased pressure and eventual rupture.
  • Chronic Otitis Media: Long-standing ear infections can weaken the eardrum, making it more susceptible to perforation.
• Trauma:
  • Barotrauma: Sudden changes in air pressure, such as during air travel or scuba diving, can cause the eardrum to rupture.
  • Direct Injury: Insertion of objects into the ear canal (e.g., cotton swabs, hairpins) can puncture the eardrum.
  • Acoustic Trauma: Exposure to extremely loud noises, such as explosions or gunshots, can cause the eardrum to tear.
• Sudden Loud Sounds: Explosions or other sudden, loud noises can cause a rapid change in pressure, leading to perforation.
• Foreign Objects: Inserting objects like cotton swabs into the ear can accidentally perforate the eardrum.
• Head Trauma: Severe head injuries can cause damage to the ear and lead to eardrum perforation.

Clinical

• Hearing Loss: A reduction in hearing ability in affected ear depends on size and location of the perforation.
• Ear Pain: Sudden and sharp pain in the ear, especially if the perforation is due to trauma or infection.
• Otorrhea: Discharge from the ear, which may be clear, bloody, or purulent (containing pus).
• Tinnitus: Ringing, buzzing, or hissing sounds in the ear.
• Vertigo: A sensation of spinning or dizziness, particularly if the inner ear is affected.
• Fullness in the Ear: A feeling of pressure or fullness in the ear.

Investigations

• Otoscopy: A perforation will be visible as a hole or tear in the eardrum.
• Tympanometry: measures the movement of the eardrum in response to changes in air pressure.
• Hearing Tests (Audiometry): To evaluate the degree of hearing loss associated with the perforation.
• Imaging: e.g. trauma or when a cholesteatoma CT scan may be performed.

Management

• Observation: most small perforations heal spontaneously within a few weeks without intervention. Patients are advised to keep the ear dry and avoid inserting anything into the ear.
• Antibiotic Therapy: If infection is present, topical or oral antibiotics may be prescribed to prevent or treat infection.
• Eardrum Patch (Myringoplasty): For larger or non-healing perforations patch over the tear to encourage healing.
• Surgical Repair (Tympanoplasty): if perforation does not heal on its own or if there is significant hearing loss, surgery may be required to repair the eardrum.
• Preventive Measures: Avoid water entering the ear canal during the healing process. Use earplugs or a waterproof dressing during bathing or swimming.
• Prognosis: is generally good, especially if treated promptly. Most small perforations heal on their own within a few weeks. However, larger perforations or those caused by chronic infections or significant trauma may require surgical intervention. Complications can include persistent hearing loss, chronic otitis media, or the development of a cholesteatoma.