Tympanic membrane perforation is a rare medical entity. There are numerous causes, of which infection, trauma, and iatrogenic consequences are the most frequent [1] [2]. Of importance, perforation results as a complication from acute and chronic otitis media [3] [4]. Moreover, one particular study found a link between recurrent acute otitis media and spontaneous perforation [5]. Iatrogenic effects stem from procedures such as ear irrigation, outcomes related to tympanostomy tubes [6] [7], or even cerumen removal. Other etiologies of perforation include blunt trauma to the ear and exposure to elevated atmospheric pressure such as with explosions, diving, and air travel [8] [9]. Specifically, tympanic membrane perforation is the most prevalent finding with ear trauma [10].

One of the main features is conductive hearing loss [11], which correlates with the size of the perforation [12]. In addition to the latter, the effects are reflective of the location of the perforation and the presence of any other existing condition. If associated with otitis media or cholesteatoma, the perforation is typically painful. Additionally, a concomitant ear infection with perforation may be associated with copious purulent drainage.

Individuals with perforation may hear whistling sounds during pressure changes situations such as sneezing or nose blowing. Additionally, affected individuals are vulnerable to infection when water enters the ear canal and during upper respiratory illness. The perforation may last for a short duration or persist. If it does not spontaneously heal, it becomes chronic with residual perforation.

• Pain

  You can take steps at home to treat ear pain. Put warm compresses on the ear to help relieve discomfort. Use medicines such as ibuprofen or acetaminophen to ease pain. [medlineplus.gov]

  Pain medication was used for a mean duration of 2.0 days, with the mean pain scale score determined to be 0.1 on the third postoperative day. [24] Inlay versus underlay surgery A study by Haksever et al found that inlay butterfly transcanal cartilage [emedicine.medscape.com]

  Other symptoms may include sharp ear pain or a sudden decrease in ear pain; bloody, clear or pus-like drainage; noise or buzzing in the ear; hearing loss; and other symptoms. [nationalsinusinstitute.com]

  A ruptured or perforated eardrum usually causes pain if the cause is infectious (ear infection) or traumatic; however, other causes may not cause pain. [medicinenet.com]

• Surgical Procedure

  Many types of perforation heal on their own, but it is always important to visit your ENT doctor in Arlington, Dallas or Fort Worth to make sure you do not need a surgical procedure. [centralparkent.net]

  5 Additional materials, namely vein or fascia, soon followed the use of canal skin in the evolution of this surgical procedure.6,7 The cases reported in this paper are restricted to those persons having complete loss of the tympanic membrane before grafting [jamanetwork.com]

  Tympanic membrane perforations are usually caused by trauma, infection, surgical procedures such as tympanoplasty or myringoplasty. [dbpia.co.kr]

  In this surgical procedure, a new eardrum is harvested from the patient's own body tissue (temporalis fascia or tragal perichondrium). [fauquierent.net]

• Weakness

  Other symptoms of a ruptured eardrum may include: Bleeding from the ear Partial or total hearing loss in the affected ear Buzzing or other noises in the ear Facial weakness or dizziness Diagnosis of Tympanic Membrane Perforation Tympanic membrane perforation [vernickandgopal.com]

  In more severe cases, facial weakness or dizziness may also occur. Most ruptured eardrums will heal on their own in a few weeks without treatment. [neurotucson.com]

  […] device detonation, fireworks, lightning) Nonexplosive barotrauma blasts (slap to the ear, airbag deployment, sports, recreational water activities) Clinical presentation Both early and late presentation: Hearing loss Ear pain Nausea and vomiting Fascial weakness [visualdx.com]

  Perforations with hearing loss >40 dB, any degree of ipsilateral facial weakness, those associated with vestibular symptoms, or those associated with cholesteatoma require referral to ENT; for traumatic perforation, obtain evaluation within 48 hours. [smartypance.com]

  […] eardrum include: Sudden sharp ear pain or a sudden decrease in ear pain Drainage from the ear that may be bloody, clear, or resemble pus Ear noise or buzzing Hearing loss that may be partial or complete in the affected ear Episodic ear infections Facial weakness [webmd.com]

• Chronic Infection

  Common etiologies include acute or chronic infection, eustachian tube dysfunction, trauma, and previous ear surgery (including PE tube placement). [tricare.mil]

  Therefore a hole in this membrane increases the risk of infections as well as to cause degrees of hearing loss. A picture of a normal tympanic membrane. A perforation can be the result of trauma, or of acute and chronic infections. [sydneyentclinic.com]

  Perforations that result from infections, as when a tympanic membrane bursts, or when chronic infections have led to irreparable damage to the membrane itself, often do not heal. Figure 2. [ent.weill.cornell.edu]

  In other cases, chronic infection and drainage associated with a perforation or larger perforations will not heal on their own and may require surgical repair. [masseyeandear.org]

• Recurrent Infection

  Tympanic membrane perforations that do not heal spontaneously, even small ones, may require surgical repair, particularly when they are associated with hearing loss or recurrent infection. [medtronic.com]

  Non-healing perforations in the presence of persistent hearing loss or recurrent infections may require surgical repair ( myringoplasty ). References (1) Lou ZC et al. [entsho.com]

  Perforations may also occur following extrusion of pressure equalization tubes placed to prevent recurrent middle ear infections. [entad.org]

• Common Cold

  Parents can also make sure the child is getting proper rest and nutrition to increase resistance to the common cold and infections present in other children with whom their child plays or attends school. [healthofchildren.com]

• Fracture

  Sometimes when the tympanic membrane is perforated, the small bones of the inner ear, called ossicles, are fractured at the same time. A ruptured eardrum may cause hearing loss in the affected ear, but this is usually temporary. [vernickandgopal.com]

  Physical examination  Tympanic perforation  Central perforation  Marginal perforation  Blood crust  If skull base fracture is occurred with CSF leakage, clear fluid is observed. 6. [slideshare.net]

  There are three different types of orbital fractures: orbital rim fractures, blowout fractures and direct orbital floor fractures. [sinaigrace.org]

  Red flags Significant generalised head- or polytrauma – use the ATLS approach Battle's sign – ecchymosis (bruising) behind the ear can be a sign of skull base fracture Facial nerve palsy When to involve the ENT registrar Immediately: Temporal bone fracture [entsho.com]

  Traumatic causes of tympanic membrane perforation include Insertion of objects into the ear canal purposely (eg, cotton swabs) or accidentally Concussion caused by an explosion or open-handed slap across the ear Head trauma (with or without basilar fracture [msdmanuals.com]

• Skin Rash

  Symptoms Runny or stuffy nose Persistent coughing or sneezing Hives, redness in the skin or other skin rashes Itchy, watery eyes Treatment Your physician may ask you to go through an allergy test to determine the source of your symptoms. [sinaigrace.org]

• Tinnitus

  In our study regardless of mechanism of injury, tinnitus was the most common complaint (90.90%). [indianjotol.org]

  In these cases, you may experience a dramatic loss of hearing and tinnitus. Causes The causes of a perforation or tear in the eardrum are usually due to injury, infection, or chronic Eustachian tube disorders. [centralparkent.net]

  In this report, a 43-year-old male patient with unilateral tympanic membrane perforation, tinnitus, and bilateral sensorineural hearing loss caused by thunderbolt strike is presented through a review of the literature. [ncbi.nlm.nih.gov]

  Median size of perforations was 33.0%; Patients main complaints were blockage of the ears/ hearing loss and tinnitus. [ajol.info]

  Symptoms can include conductive hearing loss, aural fullness, pain, tinnitus, and exudate. Some patients with TM perforations may by asymptomatic. In many cases, the TM perforation heals on its own. [medtronic.com]

• Otalgia

  These patients had been referred to us for evaluation of chronic, mostly treatment-refractory otitis externa, which had manifested as otorrhea, otalgia, and/or pruritus. [ncbi.nlm.nih.gov]

  However, the majority of the patients that I see with acute traumatic tympanic membrane perforations are symptomatic, and their prime complaints are decreased hearing, tinnitus, and otalgia. [jamanetwork.com]

  Clinical manifestations  Otalgia  Bleeding  Fullness  Hearing loss: conductive HL or mixed HL  Tinnitus  Shape of perforation is split 5. [slideshare.net]

  The subject lost his consciousness temporarily at the time of the accident and was sent to an Intensive Care Unit complaining of dyspnea, intense chest pain, and bilateral otalgia and tinnitus. [bjorl.org]

• Ear Discharge

  It was significantly delayed by large perforations estimated at 50% or more of entire tympanic membrane, ear discharge, wrong intervention on acute perforation by ear syringing, and by penetrating injuries sustained through the ear canal (P < 0.05, P [ncbi.nlm.nih.gov]

  Otomicroscopic view of central perforation of tympanic membrane in a patient presenting with ear discharge and hearing loss (click on image for an enlarged view) Central perforation of tympanic membrane is that which is not involving the annulus and is [pgblazer.com]

  […] reduce the surface tension of the water and makes it more likely to pass through the perforation and into the middle ear) Advise the patient to attend their GP/local walk-in centre for ear drops if they develop ear discharge and pain Further management [entsho.com]

  You may also have ear discharge, tinnitus (ringing or buzzing sound in the ear), or dizziness. Ear discharge may be clear, bloody, or yellowish and thick. A mild eardrum perforation may heal on its own over time. [drugs.com]

• Hearing Impairment

  Conductive hearing impairment accounted for 61.6% while sensorineural hearing impairment 25.3%. The most common degrees of hearing impairment were mild and moderate and accounted for 47.1% and 25.1%, respectively. [ncbi.nlm.nih.gov]

  In this study, conductive hearing impairment is the most common type of hearing impairment and accounted for 326 (61.6%) followed by sensorineural hearing impairment in 134 (25.3%) and mixed hearing impairment in 69 (13.1%). [njcponline.com]

  Correlation of hearing impairment with site of tympanic membrane perforation. Journal of Institute of Medicine, 27 (2), 2-5. Retrieved from https://www.nepjol.info/index.php/JIOM/article/view/394 [nepjol.info]

  Determinants of Hearing Loss in Perforations of the Tympanic Membrane. Otol Neurotol. 2006;27(2):136-43. Bhusal CL, Guragian RPS, Shrivastav RP. Correlation of hearing impairment with site of tympanic membrane perforation. [ijorl.com]

  Knowledge of the degree of hearing impairment is critical and a complete hearing assessment will be obtained. [entforkidsalabama.com]

• Hearing Problem

  This can cause a hearing problem, which often is temporary. What Causes a Perforated Eardrum? Many things can tear an eardrum, such as: Using cotton swabs. [kidshealth.org]

  Will I lose my hearing if I rupture an eardrum? Although a perforated or ruptured eardrum can cause hearing problems, it does not mean that you will lose your hearing. [medicinenet.com]

  It commonly occurs in early childhood and is characterized by ear pain, fever, and hearing problems. [healthofchildren.com]

• Vertigo

  Perilymphatic fistula – Radiates to the affected ear and may be associated with severe hearing loss, vertigo, clear otorrhea. [visualdx.com]

  Manifestations Ear pain during descent that stops suddenly Clear or bloody drainage from ear Hearing loss Ringing in the ear (tinnitus) Spinning sensation (vertigo) Nausea or vomiting that can result from vertigo Management Most perforated eardrums will [diversalertnetwork.org]

  Patients with marked hearing loss or severe vertigo are evaluated by an otolaryngologist as soon as possible. Exploration may be needed to assess and repair damage. [msdmanuals.com]

  […] from vertigo When to see a doctor Call your doctor if you experience any of the signs or symptoms of a ruptured eardrum or pain or discomfort in your ears. [mayoclinic.org]

• Dizziness

  Call your provider right away after your eardrum ruptures if you: Are very dizzy Have a fever, general ill feeling, or hearing loss Have very bad pain or a loud ringing in your ear Have an object in your ear that does not come out Have any symptoms that [medlineplus.gov]

  The intraoperative dizziness scores were higher in the conventional perichondrium myringoplasty group. [ncbi.nlm.nih.gov]

  Some rare complications of a ruptured eardrum include: Long-term hearing loss Long-term vertigo Long-term dizziness Infection that can spread in the ear Persistent ear drum perforation (hole) It is typically more comfortable to keep the ear dry while [my.clevelandclinic.org]

  Other symptoms of a ruptured eardrum may include: Bleeding from the ear Partial or total hearing loss in the affected ear Buzzing or other noises in the ear Facial weakness or dizziness Diagnosis of Tympanic Membrane Perforation Tympanic membrane perforation [vernickandgopal.com]

  After the rupture, you may have: Drainage from the ear (drainage may be clear, pus, or bloody) Ear noise/buzzing Earache or ear discomfort Hearing loss in the involved ear (hearing loss may not be total) Weakness of the face, or dizziness (in more severe [mountsinai.org]

• Irritability

  The patient then instills a solution of irritative and aromatic oils daily into the ear. [emedicine.medscape.com]

  Patients wearing earmolds with total perforation experience nearly constant irritation, infection, itching, or drainage. Rare periods of success are achieved in such cases by strict adherence to hygiene and ventilation guidelines. [ncbi.nlm.nih.gov]

  Water in the middle ear is painful, irritating and may introduce bacteria. Covering the cotton plug with petroleum jelly will allow the patient to shower safely. Discussion Small uncomplicated perforations usually heal. [pt.slideshare.net]

  When you suffer from tonsillitis, your tonsils become inflamed and irritated. Your tonsils are the two (2) pads of tissue at the back of your throat. When you suffer from tonsillitis, your tonsils become inflamed and irritated. [sinaigrace.org]

A perforated tympanic membrane is identified during routine otoscopy although smaller sized ones may need otomicroscopy. If pneumatic otoscopy is done, it reveals an immobile tympanic membrane in affected patients [13].

Note that the tympanic membrane may be obscured by cerumen, foreign objects, or outgrowths of skin or cartilage that are present in the external auditory canal [14]. Additional challenges in visualizing the tympanic membrane can occur due to difficulty with proper positioning; the latter is especially seen in children.

Once a perforation is diagnosed, audiometry is performed but is usually normal. This should be repeated prior to and after any surgical procedure.

Impedance testing may be advised as well. Tympanometry in affected individuals is associated with a flat type B tympanogram, which is a finding consistent with perforation [13]. This requires specialized tools.

If the perforation is not confirmed with the above tests, another technique can be done. This involves filling the patient's affected ear canal with saline or distilled water followed by execution of the Valsalva maneuver. Consequently, the presence of stream bubbles renders this a positive result.

Imaging is only obtained if there is evidence of bone destruction or cholesteatoma. Otherwise, X-rays and magnetic resonance imaging (MRI) are not usually performed.

Office treatments The first option is to perform one of the available office treatments. Such treatments have the best chance of working when the perforation is small and involves neither the umbo nor the annulus. Several methods apply. [emedicine.medscape.com]

These patients were treated with the following prominent methods of treatment: gelatin sponge patch treatment and edge approximation plus gelfoam patching. Measurement indicators were perforation closure rate and mean closure time at 3 months. [ncbi.nlm.nih.gov]

A ruptured eardrum usually heals within a few weeks without treatment. Sometimes, however, a ruptured eardrum requires a procedure or surgical repair to heal. [mayoclinic.org]

This study aimed to retrospectively evaluate the prognosis and outcome of tympanic membrane perforations with a particular focus on the fate of the perforation edge flaps.Chart records of 329 patients with a single ear traumatic tympanic membrane perforation [ncbi.nlm.nih.gov]

The authors report that tinnitus, vertigo and hearing loss (secondary to traumatic TM perforation) often have a good prognosis, despite various and multiple therapeutic protocols and a lack of consensus as to how to "best" treat traumatic TM perforation [audiology.org]

Lou ZC, Hu YX, Tang YM (2011) Prognosis and outcome of the tympanic membrane flap at traumatic tympanic membrane perforation edge. ORL J Otorhinolaryngol Relat Spec 73: 212-218. [esciencecentral.org]

Common etiologies include acute or chronic infection, eustachian tube dysfunction, trauma, and previous ear surgery (including PE tube placement). [tricare.mil]

After obtaining a history in terms of perforation etiology and duration from occurrence to patient presentation, all patients underwent ENT and general examinations. [medcraveonline.com]

Etiology In our study, the most common etiology of traumatic perforation of TM was injury caused due to physical assault (69.42%). [indianjotol.org]

Genetics Genetic susceptibility has been reported for recurrent acute otitis media (AOM) and chronic otitis media with effusion (COME), two etiologies that may lead to the complication of TM perforation (1)[C]. [unboundmedicine.com]

Epidemiology of Acute Otitis Media in the Postpneumococcal Conjugate Vaccine Era. Pediatrics. 2017;140(3). Epub 2017/08/09. pmid:28784702 conflicts of interest to disclose. [journals.plos.org]

Epidemiology Incidence in the general population is unknown because many perforations heal spontaneously. [unboundmedicine.com]

Epidemiology of otitis media in a local tropical African population. West Afr J Med 2005;24:227-30. 25. Sarojamma DSR, Raj S, Satish HS. A clinical study of traumatic perforation of tympanic membrane. IOSR J Dent Med Sci 2014;13:24-8. 26. [phmj.org]

Eustachian tube dysfunction and inability to equalize middle ear pressures Rapid changes in ambient pressures (air flight or deep-water diving) Insertion of objects into ears, frequent cotton tip use Head trauma, exposure to explosions Etiology and Pathophysiology [unboundmedicine.com]

Pathophysiology The eardrum tends to heal itself. Even eardrums that have been perforated multiple times often remain intact. [oralmaxillo-facialsurgery.blogspot.com]

Preventions  Be caution while removing your wax  Using ear plug 9. The End [slideshare.net]

People should avoid inserting any objects into their ear, even to clean the ear, to prevent damage to the eardrum. [medicalnewstoday.com]

Seek prompt evaluation from your primary care doctor to prevent potential damage to the eardrum. Protect your ears during flight. If possible, don't fly if you have a cold or an active allergy that causes nasal or ear congestion. [mayoclinic.org]

There are multiple things that you can do to prevent future eardrum ruptures. Prevention tips Keep your ear dry to prevent further infection. Gently stuff your ears with cotton when you bathe to prevent water from entering the ear canal. [healthline.com]

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