Perforation of tympanic membrane Chunfu Dai Otolaryngology Department

Perforation of tympanic membrane Chunfu Dai Otolaryngology Department Eye Ear Nose & Throat Hospital Fudan University

Pathogensis n Direct force n n n Careless while removal wax by himself or herself Skull fracture may tear TM Hot slag fly into the ear

Pathogenesis n Indirect force n Increase in violence and firearms n Associated with more dismal outcome n More likely to involve intracranial lesions n Barotrauma n Rapid pressure fluctuations with the inner ear n Air travel or SCUBA diving n “the bends”

Associated complications Is usually associated with TM or inner ear trauma unless Iatrogenic n Ossicular discontinuity n Facial Nerve Injury n Chorda tympani Nerve Injury n Barotrauma to Stapes footplate

Clinic presentations n n n Otalgia Bleeding Fullness Hearing loss: conductive HL or mixed HL Tinnitus Shape of perforation is split

Physical examination n Tympanic perforation Central perforation n Marginal perforation n Blood crust If skull base fracture is occurred with CSF leakage, clear fluid is observed.

Diagnosis n n The key point is to exclude whether it associates with trauma to ossicular chain or to inner ear. The audiometry can provide useful informations. CHL > 40 db suspicion for ossicular discontinuity n Hearing test reveals sensorneurous HL, it means inner ear injury n

Managements n n n n Antibiotic to prevent infection Aseptic external auditory canal with alcohol Prevent super respiratory infection Prohibit nasal blow Prohibit ear drops It takes 3 -4 w to heal the ear drum If 3 months later, perforation still exists, myringoplasty is indicated.

Preventions n n Be caution while removing your wax Using ear plug