EAR DRUM PERFORATIONS
The tympanic membrane is a thin membrane that seperates the ear canal from the middle ear. It is important to note that middle ear is connected to the nose by the Eustacian tube and for this reason middle ear is considered to be an extension of the nasal cavity. Hence nasal diseases have a tendency to extend into the middle ear and can cause drum perforations.
Causes of Eardrum Perforation
The causes of perforated eardrum are from trauma or infection. Trauma can occur when:
- If the ear is struck squarely with an open hand
- With a skull fracture
- After a sudden explosion· If an object (pencil, cotton bud or match stick) is pushed too far into the ear canal
- As a result of hot slag (from welding) or acid entering the ear canal.
Middle ear infections may cause pain, hearing loss, and spontaneous rupture (tear) of the eardrum resulting in a perforation. In these circumstances, there may be infected or bloody drainage from the ear. In medical terms, this is called otitis media with perforation.
On rare occasions a small hole may remain in the eardrum after a previously placed PE tube (pressure equalizing) either falls out or is removed by the physician.
Most eardrum perforations heal spontaneously within weeks after rupture, although some may take up to several months. During the healing process the ear must be protected from water and trauma. Those eardrum perforations, which do not heal on their own, may require surgery.
The larger the perforation, the greater the loss of hearing. The location of the hole (perforation) in the eardrum also effects the degree of hearing loss. If severe trauma (e.g. skull fracture) disrupts the bones in the middle ear which transmit sound or causes injury to the inner ear structures, the loss of hearing may be quite severe.
If the perforated eardrum is due to sudden traumatic or explosive event, the loss of hearing can be great and ringing in the ear (tinnitus) may be severe. The hearing usually returns partially, and the ringing diminishes in a few days. Chronic infection as a result of the perforation can cause major hearing loss.
Before attempting any correction of the perforation, a hearing test should be performed. The benefits of closing a perforation include.
Prevention of water entering the ear while showering, bathing, or swimming (which could cause ear infection), improved hearing, and diminished tinnitus.It may prevent the development of a cholesteatoma (skin cyst in the middle ear), which can cause chronic infection and destruction of ear structures.If the perforation is very small, otolaryngologists may choose to observe the perforation over time to see if it close spontaneously. They also might try to patch a cooperative patient’s eardrum in the office.
Working with a microscope, the doctor may touch the edges of the eardrum with a chemical to stimulate growth and then place a thin paper patch on the eardrum.Usually with closure of the tympanic membrane improvement in hearing is noted. Several applications of a patch (up to three or four) may be required before the perforation closes completely. If the physician feels that a paper patch will not provide prompt or adequate closure of the hole in the eardrum, or attempts with paper patching do not promote healing, surgery is considered.
There are a variety of surgical techniques, but all basically place tissue across the perforation allowing healing. The name of this procedure is called tympanoplasty. previously the ear drum was repaired with thin facia covering muscles above the ear. This can lead to a thin drum and can result in reperforations after minor injuries. Recent techniques used at MCV Hospital utilize a very thin slice of cartilage taken from the ear itself. Using an electric slicer .2 mm cartilage slices are used to provide the middle layer of the ear drum.This gives additional strength to the new drum. Surgery is quite successful in closing the perforation permanently, and improving hearing. It is done on an inpatient basis requiring 3 days admission.. The doctor will advise regarding the proper management of a perforated eardrum.