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The perforated tympanic membrane
1Georgetown University School of Medicine, Washington, D.C.
Abstract:
Tympanic membrane perforations typically result from trauma or acute otitis media. Most perforations do not cause more than a mild conductive hearing loss, aural fullness and mild tinnitus. Blood, purulent secretions and other debris should be carefully suctioned out of the canal and the perforation size and location described. Irrigation and pneumatic otoscopy should be avoided. A history of vertigo, nausea and vomiting and an audiogram showing a conductive hearing loss of more than 30 dB suggest disruption of the ossicular chain. Profound sensorineural loss may signify inner ear nerve damage. Mastoid radiographs and computed tomographic scans may be useful in cases of significant trauma and infection. Most small perforations resolve spontaneously. The affected ear should be kept dry. Oral and topical antibiotics may be prescribed for perforations related to acute otitis media. Otolaryngologic referral may be necessary to evaluate traumatic perforations associated with vertigo or significant hearing loss, perforations from chronic otitis media or perforations from acute otitis media that do not heal within one month.
Insights
Tympanic membrane perforations from trauma or infection usually cause mild hearing loss. Most small perforations heal on their own, but significant issues may require medical attention.
Area of Science:
- Otolaryngology
- Audiology
Background:
- Tympanic membrane perforations commonly stem from trauma or acute otitis media.
- Most perforations result in mild conductive hearing loss, aural fullness, and tinnitus.
Purpose of the Study:
- To outline the evaluation and management of tympanic membrane perforations.
- To identify indicators for potential complications and the need for specialist referral.
Main Methods:
- Clinical examination including suctioning of the ear canal and description of perforation.
- Patient history assessment for vertigo, nausea, and vomiting.
- Audiometry to quantify hearing loss; imaging (radiographs, CT scans) for complex cases.
Main Results:
- Conductive hearing loss over 30 dB or sensorineural loss suggests ossicular chain or inner ear damage.
- Small perforations often resolve spontaneously with conservative management.
- Complicated cases may involve the ossicular chain, inner ear, or chronic infection.
Conclusions:
- Conservative management (keeping the ear dry, antibiotics if needed) is appropriate for most tympanic membrane perforations.
- Referral to otolaryngology is indicated for traumatic perforations with significant symptoms, chronic perforations, or non-healing acute perforations.