The document summarizes tympanic membrane perforations, or ruptures in the eardrum. It discusses the anatomy of the ear and causes of perforations, which can include infections, trauma, explosions, and surgery. Perforations are classified based on their location in the eardrum and cause. Symptoms include hearing loss, pain, and discharge. Diagnosis involves examination with an otoscope. Treatment involves antibiotics, analgesics, and sometimes surgery to repair or reconstruct the eardrum. Nursing care focuses on pain management, prevention of infection, and patient education.

1. TYMPANIC MEMBRANE
PERFORATIONS
Abhilash Kumar
BSc (N) 3rd year

2. INTRODUCTION
✓ TYMPANIC MEMBRANE PERFORATIONS also called as
eardrum perforation is an injury of the TYMPANIC MEMBRANE .
✓ The tympanic membrane is a delicate, thin membrane present
in the middle ear which is responsible for conducting the
soundwaves to the inner part of the ear via vibrations .
✓ Damage to the eardrum can results in partial or complete
hearing loss , tinnitus and other symptoms .

3. DEFINITIONS
“Tympanic membrane perforation can be defined as a rupture or
perforation (hole) of the ear drum which can occur as a result of otitis
media , trauma , explosions , noise or surgery “ .
“ According to Javed Ansari “
“ A perforated ear drum or punctured ear drum is a hole in the tissue that
separates the auditory canal from inner ear .
“ According to J.M Hawk “

4. ANATOMY AND PHYSIOLOGY
OF THE MIDDLE EAR

5. ✓ EAR is the organ of hearing and balance .
✓ The human ear can be divided into 3 parts :-
1- External Ear
2- Middle Ear
3- Inner Ear
EXTERNAL EAR :
The external ear consist of :- (a) pinna or auricle
.(b) external auditory canal

6. MIDDLE EAR :
Middle ear is consist of : (a) Tympanic membrane
.(b) Auditory ossicles
.(I) malleus
.(ii) incus
.(iii) stapes
INNER EAR :
The inner ear is consist of the labyrinth
.(a) cochlea
.(b) vestibule
.(c) semicircular canals

8. INCIDENCE
The prevalence of tympanic membrane perforation is 2.1 % among the
general population totalling to 0.2 millions adolescents , 3.3 million
adults and 2.8 million older adults .
Both male and female are equally affected .

9. TYPES OF TM PERFORATION
On the basis of location of the perforation ear drum perforation can
be classified as :
(a) Marginal perforation
(b) central perforation
(c) Attic perforation

10. MARGINAL TM PERFORATION :
In marginal TM perforation the
perforation occurs at the margins
of the ear drum where the ear
drum is attached to the auditory
canal .

11. CENTRAL TM PERFORATION :
The perforation occurs at the
centre part of the TYMPANIC
MEMBRANE

12. ATTIC TM PERFORATION :
The perforation occurs at the
superior part of the tympanic
membrane.

13. Continued…..
On the basis of cause of the perforation ear drum perforation can be of:
(1) PATHOGENIC PERFORATION ;
Pathogenic perforation of the tympanic membrane are caused by
bacterial , viral , fungal infection
(2) NONPATHOGENIC / TRAUMATIC PERFORATION ;
Nonpathogenic perforation are those caused by physical, chemical
or environmental agents

14. CAUSES / ETIOLOGY

15. 1. FOREIGN BODIES

17. 2. SUDDEN CHANGE IN
ATMOSPHERIC PRESSURE

19. 3. FALL INJURY

21. 4. NOISE POLLUTION

23. 5. INSECT MENIFESTATION

25. 6. INFECTIONS

26. 1. BACTERIAL INFECTION
• STREPTOCOCCUS PNEUMONIAE
•. STREPTOCOCCUS PYOGENES
•. NONTYPABLE HAEMOPHILUS INFLUENZA
•. STAPHYLOCOCCUS AUREUS
2. VIRUSES
• VERICELLA ZOSTER
• VARIOLA VIRUS
3. FUNGAL INFECTION
• CANDIDA ALBICANS

27. RISK FACTORS
(1) chronic use of antibiotics
(2) unhygienic practices
(3) travel by air
(4) underwater diving
(5) sinusitis
(6) prolonged use of headphones
(7) Head injuries
(8) Hard sneezing
(9) Heavy lifting
(10) upper respiratory tract
infection

28. PATHOPHYSIOLOGY

29. CLINICAL FEATURES

30. OTALGIA

31. BLEEDING FROM EAR

32. FULLNESS OF EAR

33. HEARING LOSS

34. TINNITUS

35. DISCHARGE FROM EAR

36. FEVER

37. DISORIENTION

38. DIAGNOSTIC EVALUATION
(a) History collection
(b) physical examination
(c) otoscope
(d) tympanogram
(e) Weber test
(f) Rinne test
(g) Audiometry

39. OTOSCOPE

41. TYMPANOGRAM / TYMPANOMETRY

43. MANAGEMENT

44. MEDICAL MANAGEMENT
1. NON PHARMACOLOGICAL MANAGEMENT :
✓. Hot application is applied to relieve discomfort .
✓. Aseptic cleaning of the acoustic canal is done .
✓. Swimming or allowing water into the ears is avoided until recovery .
✓. Prohibit nasal blow and ear drops .
✓. A water proof dressing should be applied over the affected ears .

45. 2. PHARMACOLOGICAL MANAGEMENT
(A) ANTIBIOTICS MEDICATION :
Tab . Amoxicillin 500 mg
Tab . Amphicillin 450 mg
(B) ANALGESIC MEDICATION :
Inj . Diclofenac 75 mg
Inj . Tramadol. 100 mg
(C) ANTIPYRATIC MEDICATION :
Tab . Paracetamol 550 mg
(D) ANTIALLERGIC MEDICATION :
Tab . Cetrizine 5mg
Tab . Cyclizine 50 mg

46. SURGICAL MANAGEMENT
(A) TYMPANOPLASTY :
It is the surgical correction of the perforated eardrum . In
TYMPANOPLASTY a graft is placed to restore the damaged tympanic
membrane along with auditory ossicles .

47. (B) OSSICULOPLASTY :
The surgical procedure of reconstruction of ossicles with
prosthesis to carry sound to inner ear is called OSSICULOPLASTY .

48. (C) MYRINGOPLASTY :
Closure of a PERFORATION in the tympanic membrane with a graft is
known as MYRINGOPLASTY, this doesn't involve the middle ear .

49. (C) TYMPANECTOMY :
TYMPANECTOMY is the surgical removal of the
tympanic membrane .

50. NURSING MANAGEMENT :
NURSING DIAGNOSIS :
● Acute pain related to disease condition as evidence by facial
expression .
● Altered auditory sense perception related to ruptured
tympanic membrane as evidence by bleeding and hearing
acuity
● Risk for infection related to EUSTACHIAN TUBE
DYSFUNCTION as evidence by fever .
● Anxiety related to hospital environment as evidence by
verbalization .
● Knowledge deficit related to disease condition as evidence by
asking frequent questions

51. COMPLICATIONS
● Complete hearing loss
● Meningitis
● Mastoiditis
● EUSTACHIAN TUBE infection
● Tinnitus
● Ear discharge
● Headache
● Ossicular discontinuity
● Chorda tympani nerve injury
● DISORIENTION
● Drowsyness

52. PREVENTION AND
HEALTH EDUCATION

53. SUMMARY

54. THANK YOU !!
Seminar conducted by Abhilash Kumar