Tympanic membrane perforation A perforated eardrum or punctured

Tympanic membrane perforation A perforated eardrum or punctured eardrum is a rupture or perforation (hole) of the eardrum which can occur as a result of otitis media (ear infection), trauma (e. g. by trying to clean the ear instruments), explosion, with noise (accidental creation of a rupture) or sharp surgery

Etiological factors �Infections of the middle ear – damage the eardrum �Direct injury to the ear – punch to the ear �A sudden loud noise – explosion �Barotrauma – altitude change, pressure varies. �During cleaning the ear �Rupture during surgery

Clinical features �Pain �Discomfort �Hearing change or loss �Fullness of ear �Ringing sensation – tinnitus �Blood tinged discharge from ear �Pus discharge when the cause is otitis media �vertigo

Types of eardrum perforations Perforation at margin of the eardrum �This is a perforation that occurs at the margin of the eardrum - where the eardrum and ear canal come together. Central eardrum perforation �A perforation can occur in any location on the eardrum. The size of the perforation varies from a small opening to a total (entire) eardrum perforation. Attic perforation of the eardrum �This is a perforation in the superior part of the eardrum. This is referred as an attic

Diagnostic procedures �History collection �Physical examination �Otoscopic examination �Tympanometry – to note the pressure �Audiometry – hearing test

Management – medical �No treatment is needed in mild cases. �Tympanic membrane with small torn and holes will heal by itself in most cases. �A torn (perforated) eardrum will usually heal by itself within 6 -8 weeks. �Advise the patient to keep the ear dry and clean. �Avoid water getting into the ear – apply cotton while showering or washing hair. �Avoid swimming until it healed.

�Antibiotics can be prescribe if any risk for infection �Analgesics for otalgia �If perforated eardrum is due to foreign body in the ear, do not try to remove it self.

Surgical management �Indication – unhelaed torns and large torns �Tympanoplasty – it is the surgical correction of the perforated eardrum �Myringoplasty – closure of perforation is called as myringoplasty �Ossiculoplasty – ossicular reconstruction is called ossiculoplasty

Tympanoplasty �Microsurgical procedure uses patients own tissues (autologous grafts) to reconstruct the tympanic membrane �Grafts may be taken from different areas includes temporalis facia. �Alloderm grafts (from synthetic materials) may be used if patients have multiple previous surgeries �Homografts and xenografts have less successful rate

Approches �Post aural �End aural �Trans canal

Post aural and end aural approach

Trans canal approach

Classification of tympanoplasty �Type I – involves repair of the tympanic membrane alone (myringoplasty) �Type II – involves repair of the TM and middle ear in spite of slight defects in the ossicles �Type III – involves removal of ossicles when a large defect of malleus and incus. In this tympanic membrane is repaired and directly connected into the stapes �Type IV – repair when the stapes foot plate is movable but ligament is missing �Type V – repair of fixed stapes footplate.

Complication of surgery �Bleeding or infection �pain �Facial nerve palsy – rarely permanent �Tinnitus �Loss of taste last few weeks �Dizziness for a short time �Partial or total loss of hearing may rarely occur

Activity - Avoid strenuous activity. �Walking is a normal activity that can be started straight away. �Keep the ear dry. Cover ear while taking a bath or shower. �Use cotton ball coated with Vaseline to protect the ear. �Do not lift anything heavier than 20 lb during the first postoperative week. �Sneeze with your mouth open. �Blow your nose gently or avoid blowing nose. �Avoid air travel during the first two weeks.

�Prevention �Some causes of ruptured eardrums cannot be prevented or avoided. A little caution can lower the risk. �Treat ear infections early. �Avoid flying or scuba diving if have sinus infection or upper respiratory tract infection. �During fly or scuba dive, pinch nose and swallow air frequently to help equalize the pressure. �Never put anything in your ear, even to clean it. �Wear proper ear protection such as ear plugs or protection designed for sports activities.