View source for Perforated eardrum

{{short description|Injury leading to a hole in the eardrum}}
{{Infobox medical condition (new)
| name          = Perforated eardrum
| synonyms      = Punctured eardrum
| field         = [[ENT surgery]]
| symptoms      = [[conductive hearing loss]], [[tinnitus]], [[ear pain]], [[vertigo]]
| complications = 
| onset         = 
| duration      = 
| types         = 
| causes        = [[ear infection]], [[physical trauma]], [[overpressure]], ear cleaning
| risks         = 
| diagnosis     = [[otoscopy]]
| differential  = 
| prevention    = 
| treatment     = conservative or surgery
| medication    = 
| prognosis     = 
| frequency     = 
| deaths        = 
| image         = PerforationTympan.jpg
| caption       = A completely perforated eardrum, showing the handle of the [[malleus]] (hammer bone).
}}
[[File:Normal ear drum.jpg|thumb|Normal ear drum]]
A '''perforated eardrum''' ('''tympanic membrane perforation''') is a prick in the [[eardrum]]. It can be caused by [[infection]] ([[otitis media]]), [[physical trauma|trauma]], [[overpressure]] (loud [[noise]]), inappropriate [[ear clearing]], and changes in middle ear pressure. An [[otoscope]] can be used to view the eardrum to diagnose a perforation. Perforations may heal naturally or require surgery.

== Presentation ==
A perforated eardrum leads to [[conductive hearing loss]], which is usually temporary. Other symptoms may include [[tinnitus]], [[ear pain]], [[vertigo]], or a discharge of [[mucus]].<ref name=NHSsymp>{{cite web|title=Perforated eardrum - Symptoms|url=http://www.nhs.uk/Conditions/Perforated-eardrum/Pages/Symptoms.aspx|publisher=[[National Health Service]]|access-date=17 August 2011}}</ref> [[Nausea]] and/or [[vomiting]] secondary to vertigo may occur.<ref name="auto">{{Cite web|url=https://www.mayoclinic.org/diseases-conditions/ruptured-eardrum/symptoms-causes/syc-20351879|title=Ruptured eardrum (perforated eardrum) - Symptoms and causes|website=Mayo Clinic}}</ref>

== Causes ==
A perforated eardrum can have one of many causes, such as:

* [[Infection]] ([[otitis media]]).<ref name=":2">{{Cite book|last=McGurk|first=Mark|chapter-url=https://www.sciencedirect.com/science/article/pii/B9780443100987500154|title=Essential Human Disease for Dentists|publisher=[[Churchill Livingstone]]|year=2006|isbn=978-0-443-10098-7|pages=195–204|language=en|chapter=12 - ENT Disorders|doi=10.1016/B978-0-443-10098-7.50015-4}}</ref> This infection may then spread through the middle ear and may reoccur.<ref name=":2" />
* [[Injury|Trauma]]. This may be caused by trying to clean [[ear wax]] with sharp instruments. It may also occur due to [[surgical complication]]s.<ref>{{Cite book|last1=McCain|first1=Joseph P.|chapter-url=https://www.sciencedirect.com/science/article/pii/B9781416025276000062|title=Current Therapy In Oral and Maxillofacial Surgery|last2=Kim|first2=King|publisher=[[Saunders (imprint)|Saunders]]|year=2012|isbn=978-1-4160-2527-6|pages=31–62|language=en|chapter=6 - Endoscopic Oral and Maxillofacial Surgery|doi=10.1016/B978-1-4160-2527-6.00006-2}}</ref>
* [[Overpressure]] (loud [[noise]] or [[shockwave]] from an [[explosion]]).
* Inappropriate [[ear clearing]].
* Flying with a severe [[common cold|cold]], due to changes in air pressure and blocked [[Eustachian tube]]s resulting from the cold. This is especially true on landing.{{medical citation needed|date=March 2015}}<ref>{{Cite web |title=Airplane Ear |url=https://my.clevelandclinic.org/health/diseases/17929-airplane-ear |access-date=2023-10-16 |website=Cleveland Clinic |language=en}}</ref>

== Diagnosis ==
An [[otoscope]] can be used to look at the [[ear canal]]. This gives a view of the [[ear canal]] and [[eardrum]], so that a perforated eardrum can be seen. [[Tympanometry]] may also be used.<ref>{{Citation|last=Hain|first=Timothy C.|title=Chapter 12 - Cranial Nerve VIII: Vestibulocochlear System|date=2007-01-01|url=https://www.sciencedirect.com/science/article/pii/B9781416036180100128|work=Textbook of Clinical Neurology (Third Edition)|pages=199–215|editor-last=Goetz|editor-first=Christopher G.|place=Philadelphia|publisher=W.B. Saunders|language=en|isbn=978-1-4160-3618-0|access-date=2021-11-12}}</ref>

== Treatment ==

=== Conservative management ===
A perforated eardrum often heals naturally.<ref name="auto" /><ref>{{Cite book|last=Martin|first=Lisa|chapter-url=https://www.sciencedirect.com/science/article/pii/B9780123809209000432|title=The Laboratory Rabbit, Guinea Pig, Hamster, and Other Rodents|publisher=[[Academic Press]], American College of Laboratory Animal Medicine|year=2012|isbn=978-0-12-380920-9|pages=1009–1028|language=en|chapter=43 - Chinchillas as Experimental Models|doi=10.1016/B978-0-12-380920-9.00043-2}}</ref> It may heal in a few weeks or may take up to a few months.<ref name="auto" />

=== Surgery ===
Some perforations require surgical intervention.<ref name=":2" /> This may take the form of a paper patch to promote healing (a simple procedure by an [[ear, nose and throat specialist]]), or surgery ([[tympanoplasty]]).<ref name="auto" /> However, in some cases, the perforation can last several years and will be unable to heal naturally. For patients with persistent perforation, surgery is usually undertaken to close the perforation. The objective of the surgery is to provide a platform of sort to support the regrowth and healing of the tympanic membrane in the two weeks post-surgery period. There are two ways of doing the surgery:

# Traditional tympanoplasty, usually using the microscope and performed through a 10&nbsp;cm incision behind the ear lobe. This technique was introduced by Wullstien and Zollner<ref>{{Cite journal|last=Zöllner|first=Fritz|date=October 1955|title=The Principles of Plastic Surgery of the Sound-Conducting Apparatus|journal=The Journal of Laryngology & Otology|volume=69|issue=10|pages=637–652|doi=10.1017/s0022215100051240|pmid=13263770 |issn=0022-2151|doi-access=free}}</ref> and popularized by the Jim Sheehy at the House Ear Institute.<ref name=":0">{{Cite journal|last1=Sheehy|first1=J. L.|last2=Glasscock|first2=M. E.|date=1967-10-01|title=Tympanic Membrane Grafting With Temporalis Fascia|url=http://archotol.jamanetwork.com/article.aspx?articleid=601097|journal=Archives of Otolaryngology–Head & Neck Surgery|language=en|volume=86|issue=4|pages=391–402|doi=10.1001/archotol.1967.00760050393008|pmid=6041111|issn=0886-4470|url-access=subscription}}</ref>
# Endoscopic tympanoplasty, usually using the endoscope through the ear canal without the need for incision. This technique was introduced and popularized by Professor Tarabichi of TSESI: Tarabichi Stammberger Ear and Sinus Institute.<ref name=":1">{{Cite journal|last1=Tarabichi|first1=Muaaz|last2=Poe|first2=Dennis S.|last3=Nogueira|first3=João Flávio|last4=Alicandri-Ciufelli|first4=Matteo|last5=Badr-El-Dine|first5=Mohamed|last6=Cohen|first6=Michael S.|last7=Dean|first7=Marc|last8=Isaacson|first8=Brandon|last9=Jufas|first9=Nicholas|last10=Lee|first10=Daniel J.|last11=Leuwer|first11=Rudolf|date=October 2016|title=The Eustachian Tube Redefined|url=https://linkinghub.elsevier.com/retrieve/pii/S0030666516301153|journal=Otolaryngologic Clinics of North America|language=en|volume=49|issue=5|pages=xvii–xx|doi=10.1016/j.otc.2016.07.013|pmid=27565395|url-access=subscription|hdl=11380/1137740|hdl-access=free}}</ref>

The success of surgery is variable based on the cause of perforation and the technique being used. Predictors of success include traumatic perforation, dry ear, and central perforations. Predictors of failure includes young age and poor Eustachian tube function.<ref name=":0" />  The use of minimally invasive endoscopic technique does not reduce the chance of successful outcome.<ref name=":1" /> Hearing is usually recovered fully, but chronic infection over a long period may lead to permanent hearing loss. Those with more severe ruptures may need to wear an [[ear plug]] to prevent water contact with the ear drum.

== References ==
{{Reflist}}

== External links ==
{{Medical resources
|  Image          = PerforationTympan.jpg   
|  Caption        =  
|  DiseasesDB     = 13473  
|  ICD10          = {{ICD10|H|72||h|65}}, {{ICD10|S|09|2|s|00}}  
|  ICD9           = {{ICD9|384.2}}  
|  ICDO           =  
|  OMIM           =  
|  MedlinePlus    = 001038  
|  eMedicineSubj  = ent  
|  eMedicineTopic = 206  
|  MeshName       = Tympanic+Membrane+Perforation  
|  MeshNumber     = C09.218.903  
}}
{{Diseases of the ear and mastoid process}}
{{Nonmusculoskeletal injuries of head, neck, and thorax}}

[[Category:Diseases of middle ear and mastoid]]
[[Category:Injuries of head]]
[[Category:Otorhinolaryngology]]
[[Category:Otology]]