TM Perforations Beth Burlage
Mar 26, 2015
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