Download Perforation of tympanic membrane

Perforation of tympanic
membrane
Chunfu Dai
Otolaryngology Department
Eye Ear Nose & Throat Hospital
Fudan University
Pathogensis

Direct force
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Careless while removal
wax by himself or herself
Skull fracture may tear TM
Hot slag fly into the ear
Pathogenesis
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Indirect force
 Increase in violence and firearms
 Associated with more dismal outcome
 More likely to involve intracranial
lesions
 Barotrauma
 Rapid pressure fluctuations with the
inner ear
 Air travel or SCUBA diving
 “the bends”
Associated complications
Is usually associated with
TM or inner ear trauma
unless Iatrogenic
 Ossicular discontinuity
 Facial Nerve Injury
 Chorda tympani Nerve
Injury
 Barotrauma to Stapes
footplate
Clinic presentations
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Otalgia
Bleeding
Fullness
Hearing loss: conductive HL or
mixed HL
Tinnitus
Shape of perforation is split
Physical examination
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Tympanic perforation
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Central perforation
Marginal perforation
Blood crust
If skull base fracture is occurred with CSF
leakage, clear fluid is observed.
Diagnosis

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The key point is to exclude whether it
associates with trauma to ossicular chain
or to inner ear.
The audiometry can provide useful
informations.
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CHL > 40db suspicion for ossicular
discontinuity
Hearing test reveals sensorneurous HL, it
means inner ear injury
Managements
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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


Be caution while removing your
wax
Using ear plug