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Eardrum Perforation

Perforation of the eardrum is a rupture of the tympanic membrane. Such injury may cause otitis media and hearing loss.

Causes

The usual cause of perforated eardrum is trauma: the deliberate or accidental insertion of sharp objects (cotton swabs, bobby pins) or sudden excessive changes in pressure (explosion, a blow to the head, flying, or diving). The injury may also result from untreated otitis media and, in children, acute otitis media.

Signs and symptoms

Typical symptoms include sudden ear pain, hearing loss, dizziness, ringing in the ear, and bleeding or discharge from the ear. Signs of a serious problem are hearing loss in both ears, severe dizziness, or feeling as though you are spinning.

Diagnosis

Severe earache and bleeding from the ear with a history of trauma strongly suggest a perforated eardrum; direct visualization of the perforated tympanic membrane with an otoscope confirms it. Additional diagnostic measures include audiometric testing and a check of voluntary facial movements to rule out facial nerve damage.

Treatment

In bleeding from the ear, use a sterile, cotton-tipped applicator to absorb the blood, and check for purulent drainage or evidence of cerebrospinal fluid leakage. A culture of the specimen may be ordered. Irrigation of the ear is absolutely contraindicated.

Apply a sterile dressing over the outer ear, and refer the patient to an ear specialist. Most perforations heal rapidly, and after 2 weeks, any crust remaining on the tympanic membrane may be removed under magnification to see if healing is complete.

If the perforation has not healed in 1 month, an attempt may be made to close it in the office by the Derlacki method. In this method, the margin of the perforation is stimulated and then covered with a moist cotton disk for a few weeks. If there is no response after 3 months, as evidenced by repeated discharge, surgical closure should be recommended. A large perforation with uncontrolled bleeding may require immediate surgery to approximate the ruptured edges. Additional treatment may include a mild analgesic, a sedative to decrease anxiety, and an oral antibiotic.

Prevention

• To prevent damage to the ear during airplane travel, frequent swallowing (not chewing) is helpful.  Decongestants such as pseudoephedrine also help.
• Before discharge, tell the patient not to blow his nose or get water in his ear canal until the perforation heals.
• While the tympanic membrane is healing, the ear canal should be protected from dirt and water by a cotton plug or dry dressing.