Perforation of tympanic membrane

1. Perforation of tympanic membrane Chunfu Dai Otolaryngology Department Eye Ear Nose & Throat Hospital Fudan University

2. Pathogensis • Direct force • Careless while removal wax by himself or herself • Skull fracture may tear TM • Hot slag fly into the ear

3. Pathogenesis • Indirect force • Increase in violence and firearms • Associated with more dismal outcome • More likely to involve intracranial lesions • Barotrauma • Rapid pressure fluctuations with the inner ear • Air travel or SCUBA diving • “the bends”

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. Clinic presentations • 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 • The key point is to exclude whether it associates with trauma to ossicular chain or to inner ear. • The audiometry can provide useful informations. • CHL > 40db suspicion for ossicular discontinuity • Hearing test reveals sensorneurous HL, it means inner ear injury

8. Managements • Antibiotic to prevent infection • Aseptic external auditory canal with alcohol • Prevent super respiratory infection • Prohibit nasal blow • Prohibit ear drops • It takes 3-4 w 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