ENT

1. Tympanic Membrane
Perforation
Mr. Binu Babu
M.Sc. Nursing
Mrs. Jincy Ealias
M.Sc. Nursing

2.  Tympanic membrane perforation is the rupture of
the tympanic membrane.

3. Etiology
 Ear infection
 Trauma
 Careless while removing wax
 Skull fractures
 Barotrauma
 Severe blow to the ear
 Foreign bodies that have been pushed too far into
the external auditory canal.

4. Pathophysiology
Infection or trauma
Increase pressure in the middle ear
Pressure builds up and pushes against the eardrum.
When the pressure further increases
Eardrum perforate
Injury may extends to the ossicles and to the inner ear

5. Clinical features
 Otalgia
 Bleeding
 Fullness
 Hearing loss: that may be partial or complete in the
affected ear
 Tinnitus
 Drainage
 Dizziness

6. Types
 Marginal Perforation
 Central perforation
 Attic perforation

7.  Marginal Perforation : perforation that occurs at
the margin of the eardrum - where the eardrum and
ear canal come together.
 Central perforation: perforation at the central
part of the eardrum.
 Attic perforation: perforation in the superior part
of the eardrum.

8. Diagnostic measures
 History collection
 Physical examination
 Otoscopy
 Audiometry
 Tympanometry

9. Management
Medical management
 Typically, no specific treatment is needed for a ruptured
eardrum. The vast majority of ruptured eardrums heal within
three months.
 A tympanic membrane perforation heals spontaneously within
weeks to months after rupture.
 Antibiotic to prevent infection.
 Analgesics to reduce pain
 Warmth may be applied also to relieve discomfort.
 Aseptic cleansing of external auditory canal with alcohol
 Prevent upper respiratory infection
 Prohibit nasal blow
 Prohibit ear drops
 While healing the ear must be protected from water
 If 3 months later, perforation still exists, surgical management is
indicated.

10. Surgical management
A surgery to patch a hole in the tympanic membrane is
indicated for non-healing perforations.
 Myringoplasty : Closure of perforation is called
Myringoplasty. For a small, dry, central perfusion caused
by trauma.
 Tympanoplasty : For a large, central perforation or
marginal perforation or perforation caused by an ear
infection. It is the surgical repair of the tympanic
membrane. In this, tissue commonly from the temporalis
fascia is placed across the perforation to allow healing.
Alloderm grafts (from synthetic materials) may be used if
patients have multiple previous surgeries

11.  Ossiculoplasty – ossicular reconstruction if ossicle is
involved.

12. Tympanoplasty

13. Classification of tympanoplasty
 Type I – involves repair of the tympanic membrane
alone (myringoplasty)
 Type II – involves repair of the TM and middle ear
in spite of slight defects in the ossicles
 Type III – involves removal of ossicles when a large
defect of malleus and incus. In this tympanic
membrane is repaired and directly connected into
the stapes
 Type IV – repair when the stapes foot plate is
movable but ligament is missing
 Type V – repair of fixed stapes footplate.

14. Complication of surgery
 Bleeding or infection
 Pain
 Facial nerve palsy – rarely but permanent
 Tinnitus
 Loss of taste last few weeks
 Dizziness for a short time
 Partial or total loss of hearing may rarely occur

15. Post op care
 Keep the ear dry.
 Cover ear while taking a bath or shower.
 Use cotton ball coated with Vaseline to protect the
ear.
 Do not lift anything heavy objects during the first
postoperative week.
 Sneeze with mouth open.
 Blow nose gently or avoid blowing nose.
 Avoid air travel during the first two weeks.