A perforated eardrum, which results from a rupture of the tympanic membrane, may cause hearing loss.
The usual cause of a perforated eardrum is trauma: the deliberate or accidental insertion of a sharp object (such as a hair pin) or a sudden excessive change inpressure (from an explosion, a blow to the head, flying, or diving). The injury may also result from untreated otitis media and, in children, from acute otitis media.
Especially if untreated, a perforated eardrum can result in infection, such as mastoiditis and meningitis, and permanent hearing loss.
The patient’s history usually reveals some type of mild or severe trauma to the ear. The patient may report introducing a foreign object into the ear, or he may have amiddle ear infection.The patient may complain of the sudden onset of a severe earache and bleeding from the ear, usually the first indications of a perforated eardrum. He may also reporthearing loss, tinnitus, and vertigo.During the assessment, you may observe signs of hearing loss such as the patient turning his unaffected ear toward you when you speak. If inspection of the outerear reveals drainage, note its color and odor: Purulent otorrhea within 24 to 48 hours of injury signals infection.An otoscopic examination reveals the perforated tympanic membrane and confirms the diagnosis.A neurologic examination of the facial nerves should reveal normal voluntary facial movements if no facial nerve damage occurred from the injury.Diagnostic testsAudiometric testing allows evaluation of middle ear function.Culture of the drainage can identify a causative organism, if infection caused the rupture. X-rays of the temporal lobe and skull are used to determine if there is anassociated fracture, especially when a bad fall causes the perforation.
Most eardrum perforations heal spontaneously in a few weeks. If any crust remains on the tympanic membrane after 2 weeks, an ear specialist removes it undermagnification to see if healing is complete. If necessary, treatment includes local and systemic antibiotic therapy and analgesics for pain.A large perforation with uncontrolled bleeding may require immediate surgery to approximate the ruptured edges. If the patient needs surgical closure, he mayundergo a myringoplasty or tympanoplasty.