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

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

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

4. Associated complications Is usually associated with TM or inner ear trauma unless Iatrogenic Ossicular discontinuity Ossicular discontinuity Facial Nerve Injury Facial Nerve Injury Chorda tympani Nerve Injury Chorda tympani Nerve Injury Barotrauma to Stapes footplate Barotrauma to Stapes footplate

5. Clinic presentations Otalgia Otalgia Bleeding Bleeding Fullness Fullness Hearing loss: conductive HL or mixed HL Hearing loss: conductive HL or mixed HL Tinnitus Tinnitus Shape of perforation is split Shape of perforation is split

6. Physical examination Tympanic perforation Tympanic perforation Central perforation Central perforation Marginal perforation Marginal perforation Blood crust Blood crust If skull base fracture is occurred with CSF leakage, clear fluid is observed. 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 key point is to exclude whether it associates with trauma to ossicular chain or to inner ear. The audiometry can provide useful informations. The audiometry can provide useful informations. CHL > 40db suspicion for ossicular discontinuity CHL > 40db suspicion for ossicular discontinuity Hearing test reveals sensorneurous HL, it means inner ear injury Hearing test reveals sensorneurous HL, it means inner ear injury

8. Managements Antibiotic to prevent infection Antibiotic to prevent infection Aseptic external auditory canal with alcohol Aseptic external auditory canal with alcohol Prevent super respiratory infection Prevent super respiratory infection Prohibit nasal blow Prohibit nasal blow Prohibit ear drops Prohibit ear drops It takes 3-4 w to heal the ear drum It takes 3-4 w to heal the ear drum If 3 months later, perforation still exists, myringoplasty is indicated. If 3 months later, perforation still exists, myringoplasty is indicated.

9. Preventions Be caution while removing your wax Be caution while removing your wax Using ear plug Using ear plug