Tympanic membrane perforation

1. TYMPANIC MEMBRANE
PERFORATION

3. Etiology
 Direct force
 Careless while removal
wax by himself or herself
 Skull fracture may tear TM
 Hot slag fly into the ear
 Indirect force
 Increase in violence and
firearms
 Barotrauma

4. 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

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

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

7. Diagnosis
 Otoscopic examination
 The audiometry can provide useful
informations.
 Conductive Hearing loss > 40db
suspicion for ossicular discontinuity
 Hearing test reveals sensori-neural
Hearing Loss, it means inner ear injury

8. Management
 Antibiotic to prevent infection
 Aseptic external auditory canal with alcohol
 Prevent super respiratory infection
 Prohibit nasal blow
 Prohibit ear drops
 It takes 3-4 weeks to heal the ear drum
 If 3 months later, perforation still exists,
myringoplasty is indicated.

9. Preventions
 Be caution while removing your wax
 Using ear plug

10. The End