Perforation of tympanic

membrane
Chunfu Dai
Otolaryngology Department
Eye Ear Nose & Throat Hospital
Fudan University

Pathogensis

Direct force

Careless while removal

wax by himself or
herself
Skull fracture may tear
TM
Hot slag fly into the ear

Pathogenesis

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

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

Clinic presentations

Otalgia
Bleeding
Fullness
Hearing loss: conductive HL or
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
CSF leakage, clear fluid is observed.

Diagnosis

The key point is to exclude whether it

associates with trauma to ossicular
chain or to inner ear.
The audiometry can provide useful
informations.

CHL > 40db suspicion for ossicular

discontinuity
Hearing test reveals sensorneurous HL, it
means inner ear injury

Managements

Antibiotic to prevent infection

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

Preventions

Be caution while removing

your wax
Using ear plug