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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

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perforation of tympanic membrane

Perforation of tympanic membrane

Chunfu Dai

Otolaryngology Department

Eye Ear Nose & Throat Hospital

Fudan University

pathogensis
Pathogensis
  • Direct force
    • Careless while removal wax by himself or herself
    • Skull fracture may tear TM
    • Hot slag fly into the ear
pathogenesis
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
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
Clinic presentations
  • Otalgia
  • Bleeding
  • Fullness
  • Hearing loss: conductive HL or mixed HL
  • Tinnitus
  • Shape of perforation is split
physical examination
Physical examination
  • Tympanic perforation
    • Central perforation
    • Marginal perforation
  • Blood crust
  • If skull base fracture is occurred with CSF leakage, clear fluid is observed.
diagnosis
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
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
Preventions
  • Be caution while removing your wax
  • Using ear plug