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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