Perforation of the tympanic membrane

Perforation of the tympanic membrane means impairment of the impermeability separating the outer and middle ear of the elastic membrane (membrana tympani), which provides perception and amplification of external sound waves.

Damage to this important part of the sound-conducting apparatus, accompanied by a loss of its integrity, is also called a rupture, although it may just be a small through hole. However, the essence of pathology does not change it.

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Causes of perforation of the tympanic membrane

In otolaryngology - depending on the cause of the damage - it is customary to distinguish the perforations of the tympanic septum of an inflammatory and traumatic nature.

Traumatic perforation of the tympanic membrane occurs when it is accidentally mechanically damaged in the process of cleaning the ear canal with matches with wrapped fleece (or cotton buds), while trying to scratch objects with itching in the itching ear. The same consequences may result in careless medical manipulation. Often, the perforation of the tympanic membrane in a child occurs when the foreign body is caught in the ear.

When the external pressure of air on the membrane sharply rises, it strongly bends towards the cavity of the middle ear and, failing to maintain compression, bursts. This can happen with air travel - at the time of climbing during takeoff or descent before landing the aircraft. Damage to the membrane as a result of the barotrauma can be, jumping into the water or deep plunging into it (with scuba diving, in violation of the safety of diving and caisson works), having received an increase in compression on the membrane impact on the ear (for example, in boxing to such trauma leads an open glove on the auricle).

In the case of a short vibro-acoustic effect on the membrane of sounds with loudness above 100-120 dB (shot, explosion, etc.), an acoustic perforation occurs. Post-traumatic perforation of the tympanic membrane is often observed with fractures of the base of the skull or temporal bone.

The cause of the inflammatory perforation of the tympal membrane is acute purulent otitis. The main causative factor of the perforation of the tympanic membrane in a child with otitis is the accumulation of purulent exudate in the tympanic cavity. On the one hand, this causes necrosis of the tissues of the membrane itself, and, on the other hand, the large volume of purulent mass accumulated in the cavity, pressing on the membrane, leads to its breakthrough. Until now, the breakthrough of the tympanic membrane with pussiness is regarded as the second stage of acute purulent inflammation of the middle ear.

As noted by otiatrs, chronic purulent inflammation of the middle ear is accompanied almost everywhere by a stable perforation of the tympanic membrane: in the center of the tympanic membrane (mesotympanal), in its upper part (epimimpanal) or immediately in both departments (epimesotimpanal).

A dry perforation of the tympanic membrane - with a significant decrease in the severity of hearing - is detected after acute catarrhal otitis or chronic purulent inflammation of the middle ear, as well as as a result of scar (adhesive) otitis.

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Symptoms of tympanic perforation

Experts identify such typical symptoms of traumatic breakthrough membrane as: acute earache, allocation of bloody form of auditory meatus, tinnitus (tinnitus), dizziness, sudden hearing loss (partial deafness).

Clinical practice shows that localization of the damage to the membrane determines the degree of deterioration in the audibility and its pathogenesis. So, when perforation touched the edges of the tympanic membrane, a person has conductive hearing impairments - a decrease in auditory conduction due to poor propagation of sound waves. In cases of acoustic traumas of the tympanic membrane, irreversible neurosensory hearing loss associated with functional disorders of the receptor apparatus of the auditory analyzer located in the inner ear is not ruled out.

Listing the main symptoms of the perforation of the tympanic membrane of inflammatory etiology, doctors call: discharge from the ear of watery exudate, otorrhea (discharge of pus from the ear), rapid reduction of painful sensations, tinnitus and steadily progressing hearing loss.

In the case of craniocerebral trauma, the symptom of destruction of the membrane is the earworm - leakage from the auditory canal of cerebrospinal fluid.

Diagnosis of tympanic perforation

Otolaryngologists diagnose perforation of the tympanic membrane by external examination of the ear and otoscopy; a detailed examination of the tympanic membrane under a microscope (omicroscopy).

To determine the degree of hearing loss, a measurement of its severity is carried out - audiometry (tone and speech). The study can be carried out using a hardware method (auditor) or tuning forks and a whisper of varying loudness according to special tables.

If there is a need to find out in what state the auditory analyzer apparatus is located, in specialized clinics one resorts to the use of digital impedance metering (performed on computer audio equipment). The conductance of impedance metering allows simultaneously to perform the study of the mobility of the tympanum (tympanometry) and to establish the level of conductivity of sound on the auditory ossicles located in the cavity of the middle ear.

It should be borne in mind that the perception of tones of 250-8000 Hz at 25 decibels is an indicator of normal hearing. The deterioration of hearing is indicated by the inability of a person to hear the tone below the level of 25 dB.

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Treatment of tympanic perforation

Treatment of the perforation of the tympanic membrane has some peculiarities, since, according to doctors-otiatrists, most often the overgrowth of a rupture or a hole in the tympanic membrane occurs by itself - by scarring. On average, this process lasts a half to two months.

And most importantly, what the therapeutic efforts are directed to, is to prevent the development of the inflammatory process in the middle ear, which can be infected after a violation of the impermeability of the tympanic membrane.

Patients with this problem need to protect the damaged ear from water ingress, and the hygiene of the auditory canal is recommended by doctors carefully: using a sterile cotton swab slightly moistened with medical alcohol, then close the passage with a dry sterile swab.

But with the development of purulent otitis media, antibacterial drops are necessarily used in the perforation of the tympanic membrane, which are used in the treatment of all purulent inflammatory diseases of the ears: Normaks, Tsipromed, Otofa.

Having in its composition a powerful antibiotic rifamycin, drops of Otofa should be buried in the ear when perforating the tympanic membrane: adults - 4-5 drops (in each ear), children - 3 drops; Bury it three times a day (children - twice a day). Ear drops of Cipromed on the basis of ciprofloxacin are used in purulent otitis with perforation of 5 drops (three times a day), but they can not be used until the age of 15 and during pregnancy. Normox drops contain the antibiotic norfloxacin and have the same contraindications as Cipromed.

It should be emphasized that these drugs do not give ototoxic effects, that is, they do not damage the innervation of the ear. But such ear drops as Polidex, Sofraks, Garazon, Otinum, Otizol, Anauran, containing ototoxic antibiotics, are strictly forbidden when perforating the tympanic membrane.

If a small hole still does not overgrow, then it can be closed with a paper patch, pretreating the edges of the hole with a means that stimulates healing. And when the rupture of the membrane is large and does not overgrow for more than two months, an operation can be performed with perforation of the tympanoplasty (or myringoplasty), restoring the integrity of the membrane by engraftment of the skin flap.

In case of dry perforation of the membrane, therapy is performed by regular ear purges - in order to restore pressure in the middle ear and improve hearing - in combination with physiotherapeutic procedures (pneumomassage of the tympanic membrane, electrophoresis, UHF, quartz).

Prevention of perforation of the tympanic membrane

The main direction of prevention is the prompt and correct treatment of inflammatory diseases of the ear, in particular of otitis media. And children - and all the colds. And you need to clean your ears correctly: do not climb with cotton buds, and wash with warm water with baby soap. The resulting sulfur plug itself can be driven even deeper into the ear, so going to the clinic will be both easier and safer (there the plugs are washed out with the used method).

Well, and on the plane do not refuse the candy that the stewardess offers: sucking candy, chewing, swallowing helps to avoid such an unpleasant barotrauma as the perforation of the tympanic membrane.

Forecast of perforation of the tympanic membrane

The problem with rupture of the drum membrane, in general, is solved with a positive prognosis for further hearing. And only possible consequences of the perforation of the tympanic membrane leave no room for optimistic evaluation.

The most unfavorable consequences are the attachment of infection in the form of acute purulent inflammation of the middle ear, and in the case of inflammation - the transition of inflammation to a chronic form or possible secondary infection.

Against the backdrop of the chronicle, the hearing deteriorates almost irreversibly. In addition, the development of such pathologies is possible:

• labyrinthitis (inflammation of the inner ear);
• mastoiditis (inflammation of the mastoid process);
• thrombosis of sigmoid venous sinus of the brain (with subsequent infection of the thrombus, complete blockage of the venous collector and inflammation of its wall);
• cholesteatoma of the middle ear (cystic formation due to growth of the epithelium of the ear canal through the opening with perforations of the eardrum);
• paralysis of the facial nerve;
• intracranial infections.

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