Perforated eardrum

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Perforated eardrum
Other namesPunctured eardrum
PerforationTympan.jpg
A completely perforated eardrum, showing the handle of the malleus (hammer bone).
Specialty ENT surgery
Symptoms conductive hearing loss, tinnitus, ear pain, vertigo
Causes ear infection, physical trauma, overpressure, ear cleaning
Diagnostic method otoscopy
Treatmentconservative or surgery
Normal ear drum Normal ear drum.jpg
Normal ear drum

A perforated eardrum (tympanic membrane perforation) is a prick in the eardrum. It can be caused by infection (otitis media), 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.

Contents

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. [1] Nausea and/or vomiting secondary to vertigo may occur. [2]

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. [6]

Treatment

Conservative management

A perforated eardrum often heals naturally. [2] [7] It may heal in a few weeks or may take up to a few months. [2]

Surgery

Some perforations require surgical intervention. [3] 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). [2] 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:

  1. 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 [8] and popularized by the Jim Sheehy at the House Ear Institute. [9]
  2. 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. [10]

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. [9] The use of minimally invasive endoscopic technique does not reduce the chance of successful outcome. [10] Hearing is usually recovered fully, but chronic infection over a long period may lead to permanent hearing loss. Those with more severe ruptures may need to wear an ear plug to prevent water contact with the ear drum.

Related Research Articles

<span class="mw-page-title-main">Middle ear</span> Portion of the ear internal to the eardrum, and external to the oval window of the inner ear

The middle ear is the portion of the ear medial to the eardrum, and distal to the oval window of the cochlea.

<span class="mw-page-title-main">Cholesteatoma</span> Medical condition

Cholesteatoma is a destructive and expanding growth consisting of keratinizing squamous epithelium in the middle ear and/or mastoid process. Cholesteatomas are not cancerous as the name may suggest, but can cause significant problems because of their erosive and expansile properties. This can result in the destruction of the bones of the middle ear (ossicles), as well as growth through the base of the skull into the brain. They often become infected and can result in chronically draining ears. Treatment almost always consists of surgical removal.

<span class="mw-page-title-main">Eardrum</span> Membrane separating the external ear from the middle ear

In the anatomy of humans and various other tetrapods, the eardrum, also called the tympanic membrane or myringa, is a thin, cone-shaped membrane that separates the external ear from the middle ear. Its function is to transmit sound from the air to the ossicles inside the middle ear, and thence to the oval window in the fluid-filled cochlea. The ear thereby converts and amplifies vibration in the air to vibration in cochlear fluid. The malleus bone bridges the gap between the eardrum and the other ossicles.

<span class="mw-page-title-main">Otitis media</span> Inflammation of the middle ear

Otitis media is a group of inflammatory diseases of the middle ear. One of the two main types is acute otitis media (AOM), an infection of rapid onset that usually presents with ear pain. In young children this may result in pulling at the ear, increased crying, and poor sleep. Decreased eating and a fever may also be present. The other main type is otitis media with effusion (OME), typically not associated with symptoms, although occasionally a feeling of fullness is described; it is defined as the presence of non-infectious fluid in the middle ear which may persist for weeks or months often after an episode of acute otitis media. Chronic suppurative otitis media (CSOM) is middle ear inflammation that results in a perforated tympanic membrane with discharge from the ear for more than six weeks. It may be a complication of acute otitis media. Pain is rarely present. All three types of otitis media may be associated with hearing loss. If children with hearing loss due to OME do not learn sign language, it may affect their ability to learn.

<span class="mw-page-title-main">Eustachian tube</span> Tube connecting middle ear to throat

The Eustachian tube, also called the auditory tube or pharyngotympanic tube, is a tube that links the nasopharynx to the middle ear, of which it is also a part. In adult humans, the Eustachian tube is approximately 35 mm (1.4 in) long and 3 mm (0.12 in) in diameter. It is named after the sixteenth-century Italian anatomist Bartolomeo Eustachi.

<span class="mw-page-title-main">Conductive hearing loss</span> Medical condition

Conductive hearing loss (CHL) occurs when there is a problem transferring sound waves anywhere along the pathway through the outer ear, tympanic membrane (eardrum), or middle ear (ossicles). If a conductive hearing loss occurs in conjunction with a sensorineural hearing loss, it is referred to as a mixed hearing loss. Depending upon the severity and nature of the conductive loss, this type of hearing impairment can often be treated with surgical intervention or pharmaceuticals to partially or, in some cases, fully restore hearing acuity to within normal range. However, cases of permanent or chronic conductive hearing loss may require other treatment modalities such as hearing aid devices to improve detection of sound and speech perception.

A myringotomy is a surgical procedure in which an incision is created in the eardrum to relieve pressure caused by excessive buildup of fluid, or to drain pus from the middle ear. A tympanostomy tube may be inserted through the eardrum to keep the middle ear aerated for a prolonged time and to prevent reaccumulation of fluid. Without the insertion of a tube, the incision usually heals spontaneously within two to three weeks. Depending on the type, the tube is either naturally extruded in 6 to 12 months or removed during a minor procedure.

<span class="mw-page-title-main">Tympanoplasty</span> Surgical operation on the ear

Tympanoplasty is the surgical operation performed to reconstruct hearing mechanism of middle ear.

<span class="mw-page-title-main">Ear pain</span> Pain in the ear

Ear pain, also known as earache or otalgia, is pain in the ear. Primary ear pain is pain that originates from the ear. Secondary ear pain is a type of referred pain, meaning that the source of the pain differs from the location where the pain is felt.

<span class="mw-page-title-main">Tympanostomy tube</span> Medical device inserted into the eardrum

Tympanostomy tube, also known as a grommet,myringotomy tube, or pressure equalizing tube, is a small tube inserted into the eardrum via a surgical procedure called myringotomy to keep the middle ear aerated for a prolonged period of time, typically to prevent accumulation of fluid in the middle ear. The tube itself is made in a variety of designs, most often shaped like a grommet for short-term use, or with long flanges and sometimes resembling a T-shape for long-term use. Materials used to manufacture the tubes are often made from fluoroplastic or silicone, which have largely replaced the use of metal tubes made from stainless steel, titanium, or gold.

<span class="mw-page-title-main">Tympanometry</span> Acoustic evaluation of the condition of the middle ear

Tympanometry is an acoustic evaluation of the condition of the middle ear eardrum and the conduction bones by creating variations of air pressure in the ear canal.

<span class="mw-page-title-main">Otoscope</span> Medical device for examining the ears

An otoscope or auriscope is a medical device used by healthcare professionals to examine the ear canal and eardrum. This may be done as part of routine physical examinations, or for evaluating specific ear complaints, such as earaches, sense of fullness in the ear, or hearing loss.

Otomycosis is a fungal ear infection, a superficial mycotic infection of the outer ear canal caused by micro-organisms called fungi which are related to yeast and mushrooms. It is more common in tropical or warm countries. The infection may be either subacute or acute and is characterized by itching in the ear, malodorous discharge, inflammation, pruritus, scaling, and severe discomfort or ear pain. The mycosis results in inflammation, superficial epithelial exfoliation, masses of debris containing hyphae, suppuration, and pain. Otomycosis can also cause hearing loss.

A mastoidectomy is a procedure performed to remove the mastoid air cells, air bubbles in the skull, near the middle ear. This can be done as part of treatment for mastoiditis, chronic suppurative otitis media or cholesteatoma. In addition, it is sometimes performed as part of other procedures or for access to the middle ear. There are classically 5 different types of mastoidectomy:

Myringoplasty is the closure of the perforation of pars tensa of the tympanic membrane. When myringoplasty is combined with removal of scar tissue, it is called tympanoplasty. The operation is performed with the patient supine and face turned to one side. The graft material most commonly used for the surgery is temporalis fascia. The tragal cartilage and tragal perichondrium are also used as the graft by some surgeons.

<span class="mw-page-title-main">Tympanosclerosis</span> Medical condition

Tympanosclerosis is a condition caused by hyalinization and subsequent calcification of subepithelial connective tissue of the tympanic membrane and middle ear, sometimes resulting in a detrimental effect to hearing.

<span class="mw-page-title-main">Tympanic membrane retraction</span> Medical condition

Tympanic membrane retraction describes a condition in which a part of the eardrum lies deeper within the ear than its normal position.

Endoscopic ear surgery (EES) is a minimally invasive alternative to traditional ear surgery and is defined as the use of the rigid endoscope, as opposed to a surgical microscope, to visualize the middle and inner ear during otologic surgery. During endoscopic ear surgery the surgeon holds the endoscope in one hand while working in the ear with the other. To allow this kind of single-handed surgery, different surgical instruments have to be used. Endoscopic visualization has improved due to high-definition video imaging and wide-field endoscopy, and being less invasive, EES is gaining importance as an adjunct to microscopic ear surgery.

Eustachian tube dysfunction (ETD) is a disorder where pressure abnormalities in the middle ear result in symptoms.

Middle ear barotrauma (MEBT), also known to underwater divers as ear squeeze and reverse ear squeeze, is an injury caused by a difference in pressure between the external ear canal and the middle ear. It is common in underwater divers and usually occurs when the diver does not equalise sufficiently during descent or, less commonly, on ascent. Failure to equalise may be due to inexperience or eustachian tube dysfunction, which can have many possible causes. Unequalised ambient pressure increase during descent causes a pressure imbalance between the middle ear air space and the external auditory canal over the eardrum, referred to by divers as ear squeeze, causing inward stretching, serous effusion and haemorrhage, and eventual rupture. During ascent internal over-pressure is normally passively released through the eustachian tube, but if this does not happen the volume expansion of middle ear gas will cause outward bulging, stretching and eventual rupture of the eardrum known to divers as reverse ear squeeze. This damage causes local pain and hearing loss. Tympanic rupture during a dive can allow water into the middle ear, which can cause severe vertigo from caloric stimulation. This may cause nausea and vomiting underwater, which has a high risk of aspiration of vomit or water, with possibly fatal consequences.

References

  1. ↑ "Perforated eardrum - Symptoms". National Health Service . Retrieved 17 August 2011.
  2. 1 2 3 4 "Ruptured eardrum (perforated eardrum) - Symptoms and causes". Mayo Clinic.
  3. 1 2 3 McGurk, Mark (2006). "12 - ENT Disorders". Essential Human Disease for Dentists. Churchill Livingstone. pp. 195–204. doi:10.1016/B978-0-443-10098-7.50015-4. ISBN   978-0-443-10098-7.
  4. ↑ McCain, Joseph P.; Kim, King (2012). "6 - Endoscopic Oral and Maxillofacial Surgery". Current Therapy In Oral and Maxillofacial Surgery. Saunders. pp. 31–62. doi:10.1016/B978-1-4160-2527-6.00006-2. ISBN   978-1-4160-2527-6.
  5. ↑ "Airplane Ear". Cleveland Clinic. Retrieved 2023-10-16.
  6. ↑ Hain, Timothy C. (2007-01-01), Goetz, Christopher G. (ed.), "Chapter 12 - Cranial Nerve VIII: Vestibulocochlear System", Textbook of Clinical Neurology (Third Edition), Philadelphia: W.B. Saunders, pp. 199–215, ISBN   978-1-4160-3618-0 , retrieved 2021-11-12
  7. ↑ Martin, Lisa (2012). "43 - Chinchillas as Experimental Models". The Laboratory Rabbit, Guinea Pig, Hamster, and Other Rodents. Academic Press, American College of Laboratory Animal Medicine. pp. 1009–1028. doi:10.1016/B978-0-12-380920-9.00043-2. ISBN   978-0-12-380920-9.
  8. ↑ Zöllner, Fritz (October 1955). "The Principles of Plastic Surgery of the Sound-Conducting Apparatus". The Journal of Laryngology & Otology. 69 (10): 637–652. doi: 10.1017/s0022215100051240 . ISSN   0022-2151. PMID   13263770.
  9. 1 2 Sheehy, J. L.; Glasscock, M. E. (1967-10-01). "Tympanic Membrane Grafting With Temporalis Fascia". Archives of Otolaryngology–Head & Neck Surgery. 86 (4): 391–402. doi:10.1001/archotol.1967.00760050393008. ISSN   0886-4470. PMID   6041111.
  10. 1 2 Tarabichi, Muaaz; Poe, Dennis S.; Nogueira, João Flávio; Alicandri-Ciufelli, Matteo; Badr-El-Dine, Mohamed; Cohen, Michael S.; Dean, Marc; Isaacson, Brandon; Jufas, Nicholas; Lee, Daniel J.; Leuwer, Rudolf (October 2016). "The Eustachian Tube Redefined". Otolaryngologic Clinics of North America. 49 (5): xvii–xx. doi:10.1016/j.otc.2016.07.013. PMID   27565395.
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