TM Perforations

Beth Burlage

Definition

• Perforation - a hole or pattern made by or as if by piercing, in this case, in the tissue of the tympanic membrane

Anatomy

• Normal Tympanic Membrane

Types

• Central Perforation• Most common, perforation in which a

portion of the TM surrounds the hole

• Marginal Perforation• Perforation involves the edge of the

TM

Causes

• Traumatic Perforations• Penetrating Injury - these are direct

injuries which may occur when cleaning the ear with a foreign object

• Implosion - inward burst of the ear drum caused by a strike such as a slap or punch to the ear

Causes

• Resulting from Infection• Bacteria and viruses can weaken and

deteriorate the TM

Causes

• Chronic• Long-standing perforations are

possible in those who have eustachian tube problems and infections

Examples

Diagnosis

• History• Otoscopy : Perf vs. retraction pocket

• Pneumatic Otoscopy• Tympanometry : Large volume• Weber/Rinne Tests• Audiogram: Conductive/Mixed loss

Treatment

• Spontaneous healing• Avoid water• Observation• Surgery may be required• The cause of the perforation will

determine the ultimate course of treatment. Accompanying conditions should be treated medically.

Consequences

• Otorrhea• Hearing loss• Scarring

• The hearing loss will be a conductive loss; recurrence may cause scarring which can lead to a permanent conductive loss due to immobility

Prevention

• Don’t stick anything smaller than your elbow in your ear

• Medical treatment for infection

Accompanying/Rare Conditions

• A large conductive loss may point to ossicular damage

• Perforations in the posterior and superior position can lead to a cholesteatoma

• Multiple perforations may indicate tuberculosis, often in the presence of AIDS

Clincal Examples

• Experiences?

References

• Menner, A. (2003) A pocket guide to the ear. New York: Thieme.

• Madigan Army Medical Center (2006) Tympanic Membrane Performation. http://www.mamc.amedd.army.mil/referral/guidelines/ent_tmperforation.htm. Retrieved on April 12, 2008