ENT: Perforation of tympanic Membrane

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Perforation of tympanic Membrane
Etiology
Direct force
·        faulty technique of cleaning the ear/ while removing the foreign body from the ear.  
·        Forceful syringing
·        associated with head injury- skull fracture may tear Tympanic membrane
 Indirect force
·        increase in violence
·        increase in air pressure while slapping
·        rapid pressure fluctuations with the inner ear.
·        travelling in an non-pressurized air craft   blast

·        sudden fluid compression while diving
·        forceful blowing of the nose types:
Types :
·        Perforation of pars tensa
·        perforation of pars flaccida
Perforation of pars tensa 
ü central
·        small perforation
·        medium perforation
·        large perforation
·        subtotal perforation
ü central with in growing epithelium
ü marginal
ü total 
ü central
Small perforation: involves only < 10% of pars tensa
Large• involves >40% of pars tensa
Medium perforation: involves 10-40% of pars tensa
Subtotal: involves all are.sa of pars tensa reaches up to annulus fibrosis

Central with in-growing epithelium: Tympanic membrane perforation with inward margin  epithelium
Total: fibrosis of pars tensa and annulus
Clinical presentations
·        otalgia    
·        hearing loss: conductive HL or mixed HL
·        bleeding           
·        fullness
·        tinnitus
·        vertigo
Diagnosis
·        ear examination — fresh bleeding or blood clot is seen in the external auditory canal
·        orthoscopic examination
·        Tuning fork tests  
·        audiometry
Management
·        external auditory canal in the affected side should be plugged with a cotton ball
·        no ear drops should be instilled
·        no attempt should be made to clean the ear
·        antibiotics/ anti-inflammatory,  analgesics
·        nasal decongestants
·        prevent respiratory infection
·        prohibit nasal blow
·        if infected — should be treated as chronic suppurative otitis media
·        if perforation persists inspite of the conservative treatment, margins of the perforation can be cauterized with trichloroacetic acid and silver nitrate
·        if it still persists, the perforation is closed by myringoplasty or tympanoplasty
Associated complications
·        Ossicular discontinuity
·        Facial and trigeminal nerve injury

·        hearing loss

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notes.nursium.com: ENT: Perforation of tympanic Membrane
ENT: Perforation of tympanic Membrane
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