Eardrum perforation

Perforation of the eardrum means a violation of the impermeability of the elastic membrane (membrana tympani) separating the outer and middle ear, which ensures the perception and amplification of external sound waves.

Damage to this most important part of the sound-conducting apparatus, accompanied by the loss of its integrity, is also called a rupture, although it may simply be a small through hole. However, this does not change the essence of the pathology.

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Causes of Perforated Eardrum

In otolaryngology, depending on the cause of the injury, it is customary to distinguish between inflammatory and traumatic perforations of the tympanic septum.

Traumatic perforation of the eardrum occurs when it is accidentally mechanically damaged during the process of cleaning the ear canal with matches with cotton wool wound around them (or cotton swabs), or when trying to scratch an itchy ear with improvised objects. The same consequences can also result from careless medical manipulations. Often, perforation of the eardrum in a child occurs when removing a foreign body from the ear.

When the external air pressure on the membrane increases sharply, it bends strongly towards the middle ear cavity and, unable to withstand the compression, bursts. This can happen during air travel - at the moment of gaining altitude during takeoff or descending before landing. The eardrum can be damaged as a result of barotrauma by jumping into water or diving deeply into it (during scuba diving, when violating safety precautions for diving and caisson work), or by receiving a blow to the ear that increases the compression on the eardrum (for example, in boxing, such an injury is caused by a blow to the auricle with an open glove).

In case of short-term vibroacoustic impact on the eardrum of sounds with a volume of over 100-120 dB (shot, explosion, etc.), acoustic perforation occurs. Post-traumatic perforation of the eardrum is often observed in case of fractures of the base of the skull or temporal bone.

The cause of inflammatory perforation of the tympanic membrane is acute purulent otitis. The main causative factor of perforation of the eardrum in a child with otitis is the accumulation of purulent exudate in the tympanic cavity. On the one hand, this causes necrosis of the tissues of the membrane itself, and, on the other hand, a large volume of purulent mass accumulated in the cavity, pressing on the membrane, leads to its rupture. Until now, rupture of the eardrum with purulent discharge is considered the second stage of acute purulent inflammation of the middle ear.

As otologists note, chronic purulent inflammation of the middle ear is almost always accompanied by persistent perforation of the eardrum: in the center of the eardrum (mesotympanic), in its upper section (epitympanic), or in both sections at once (epimesotympanic).

And dry perforation of the eardrum - with a significant decrease in hearing acuity - is detected after acute catarrhal otitis or chronic purulent inflammation of the middle ear, as well as as a consequence of cicatricial (adhesive) otitis.

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Symptoms of a Perforated Eardrum

Experts identify the following typical signs of a traumatic rupture of the eardrum: acute pain in the ear, bloody discharge from the ear canal, noise in the ears (tinnitus), dizziness, and a sharp deterioration in hearing (partial hearing loss).

Clinical practice shows that the localization of the damage to the eardrum determines the degree of hearing impairment and its pathogenesis. Thus, when the perforation affects the edges of the eardrum, a person develops conductive hearing impairment - a decrease in auditory conductivity due to poor propagation of sound waves. In cases of acoustic trauma to the eardrum, irreversible sensorineural hearing loss associated with functional impairments of the receptor apparatus of the auditory analyzer located in the inner ear is also possible.

Listing the main symptoms of perforation of the eardrum of inflammatory etiology, doctors name: discharge of watery exudate from the ear, otorrhea (discharge of pus from the ear), rapid reduction of painful sensations, tinnitus and steadily progressing hearing loss.

In case of craniocerebral trauma, a symptom of destruction of the eardrum is auricular liquorrhea - leakage of cerebrospinal fluid from the ear canal.

Diagnosis of perforated eardrum

Otolaryngologists diagnose perforation of the eardrum using an external examination of the ear and otoscopy; a detailed examination of the eardrum under a microscope (otomicroscopy).

To determine the degree of hearing loss, its acuity is measured - audiometry (tone and speech). The study can be carried out using a hardware method (audiometer) or tuning forks and whispering of varying volume according to special tables.

If it is necessary to find out the condition of the auditory analyzer, specialized clinics resort to digital impedance analysis (performed on computer audiological equipment). Conducting impedance analysis allows simultaneously performing a study of the mobility of the eardrum (tympanometry) and establishing the level of sound conductivity to the auditory ossicles located in the middle ear cavity.

It should be borne in mind that the perception of tones of 250-8000 Hz at 25 decibels is an indicator of normal hearing. Hearing impairment is indicated by a person's inability to hear tones below 25 dB.

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Treatment of perforated eardrum

Treatment of perforation of the eardrum has some peculiarities, since, as otologists claim, most often the rupture or hole in the eardrum heals on its own - by scarring. On average, this process lasts one and a half to two months.

And the main thing that therapeutic efforts are aimed at is to prevent the development of an inflammatory process in the middle ear, which can become infected after the impermeability of the eardrum is compromised.

Patients with this problem need to protect the damaged ear from water, and doctors recommend that ear canal hygiene be carried out very carefully: using a sterile cotton swab slightly moistened with medical alcohol, and then closing the passage with a dry sterile swab.

But in the development of purulent otitis media, antibacterial drops for perforation of the eardrum are required, which are used in the treatment of all purulent inflammatory diseases of the ears: Normax, Tsipromed, Otofa.

Otofa drops containing the powerful antibiotic rifamycin should be instilled into the ear for perforated eardrums: adults - 4-5 drops (in each ear), children - 3 drops; instillation should be three times a day (children - twice a day). Cipromed ear drops based on ciprofloxacin are used for purulent otitis with perforation, 5 drops (three times a day), but they cannot be used before the age of 15 and during pregnancy. Normax drops contain the antibiotic norfloxacin and have the same contraindications as Cipromed.

It should be emphasized that these drugs do not have ototoxic effects, i.e. they do not damage the innervation of the ear. But ear drops such as Polydex, Sofradex, Garazon, Otinum, Otizol, Anauran, which contain ototoxic antibiotics, are strictly prohibited for use in case of perforation of the eardrum.

If a small hole does not heal, it can be covered with a paper plaster, after treating the edges of the hole with a healing stimulant. And when the rupture of the eardrum is large and does not heal on its own for more than two months, an operation can be performed for a perforated eardrum - tympanoplasty (or myringoplasty), which restores the integrity of the membrane by grafting a skin flap.

In case of dry perforation of the eardrum, therapy is carried out by regularly blowing the ear - in order to restore pressure in the middle ear and improve hearing - in combination with physiotherapeutic procedures (pneumatic massage of the eardrum, electrophoresis, UHF, quartz).

Prevention of perforation of the eardrum

The main direction of prevention is immediate and correct treatment of inflammatory diseases of the ear, in particular otitis media. And in children - all runny noses. And you need to clean your ears correctly: do not climb with cotton swabs, but wash with warm water and baby soap. The formed sulfur plug can be driven even deeper into the ear on your own, so going to the clinic will be both easier and safer (there the plugs are washed out using a proven method).

Well, on the plane, don’t refuse a candy that the flight attendant offers: sucking on a candy, chewing, and swallowing movements help to avoid such an unpleasant barotrauma as a perforated eardrum.

Prognosis of tympanic membrane perforation

The problem with the rupture of the eardrum, in general, is solved with a positive prognosis for the further state of hearing. And only the possible consequences of perforation of the eardrum leave no room for an optimistic assessment.

The most unfavorable consequences are the addition of an infection in the form of acute purulent inflammation of the middle ear, and in the case of inflammation, the transition of the inflammation to a chronic form or possible secondary infection.

Against the background of chronic hearing deteriorates almost irreversibly. In addition, the development of such pathologies is possible:

• labyrinthitis (inflammation of the inner ear);
• mastoiditis (inflammation of the mastoid process);
• thrombosis of the sigmoid venous sinus of the meninges (with subsequent infection of the thrombus, complete blockage of the venous collector and inflammation of its wall);
• cholesteatoma of the middle ear (cystic formation due to the proliferation of the epithelium of the auditory canal through the opening during marginal perforations of the eardrum);
• facial nerve paralysis;
• intracranial infections.

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