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 Marginal 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