TYMPANIC MEMBRANE

PERFORATION

Etiology
Direct force
Careless while removal

wax by himself or hersel

f
Skull fracture may tear T
M
Hot slag fly into the ear

Indirect force
Increase in

violence and
firearms
Barotrauma

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

Clinical manifestations
Otalgia
Bleeding
Fullness
Hearing loss: conductive HL o

r mixed HL
Tinnitus
Shape of perforation is split

Physical examination
Tympanic perforation
Central perforation
Marginal perforation

Blood crust
If skull base fracture is occurred with C

SF leakage, clear fluid is observed.

Diagnosis
Otoscopic examination
The audiometry can provide useful

informations.

Conductive Hearing loss > 40db suspi

cion for ossicular discontinuity

Hearing test reveals sensori-neural H
earing Loss, it means inner ear injury

Management
Antibiotic to prevent infection
Aseptic external auditory canal with alcohol
Prevent super respiratory infection
Prohibit nasal blow
Prohibit ear drops
It takes 3-4 weeks to heal the ear drum
If 3 months later, perforation still exists, myring

oplasty is indicated.

Preventions
Be caution while removing your

wax
Using ear plug

The End