Tympanic Membrane Perforation : Causes, Symptoms, Treatment, Complications, Diagnosis

Tympanic membrane perforation is a medical term used to describe a ruptured ear drum. It is a condition where there is a tear or a hole in the thin tissue (ear drum) that separates the middle ear from the ear canal. If left untreated, this rupture in the ear drum can lead to serious complications including hearing loss. It also exposes the middle ear to the external environment making it vulnerable to infection. In most of the cases, tympanic membrane perforation heals by itself without active treatment but in severe cases, the condition may require surgical intervention.

Tympanic membrane perforation is characterized by the following signs and symptoms:

• Intermittent ear ache with discomfort and soreness
• Fluid discharge from the ears that may appear clear, pus filled or blood stained
• Hearing deficiency
• Tinnitus or ringing in the ears
• Vertigo or a feeling of spinning sensation
• Nausea and vomiting secondary to vertigo
• Headache and generalized irritation and weakness.

Tympanic membrane perforation is caused by multiple reasons. The most common causes of ruptured ear drums are listed below:

• Otitis Media Causing Tympanic Membrane Perforation: Any infection in the middle ear can lead to collection of fluids and ear discharge in the middle ear. This fluid accumulation over a period of time can lead to excessive pressure build up in this area which eventually lead to perforation of the ear drum.
• Barotrauma as a Cause of Tympanic Membrane Perforation: Exposure to extreme change in atmospheric pressure exerts pressure over the ear drum. This is because there is a difference in the air pressure inside the middle ear and the barometric pressure outside the ears. This difference in pressure on either side of the ear drum leads to rupture of the ear drum. Trauma from changes in atmospheric pressure usually occurs during travelling and with activities such as scuba diving, sky diving, flying, hiking etc.
• Acoustic Trauma Causing Tympanic Membrane Perforation: Sudden exposure to extreme loud sound (such as a bomb blast or gunshot) or repeated exposure to loud noise over a period of time (listening to loud music through ear phones or talking over phones for long hours) can lead to tympanic membrane perforation.
• Tympanic Membrane Perforation due to Insertion of Foreign Objects in Ears: Insertion of foreign objects such as cotton buds, hair pins, safety pins and other small objects in the ear canal can lead to perforation of the ear drum.
• Accidents and Trauma as a Cause of Tympanic Membrane Perforation: Injuries such as head injuries, skull fracture and sudden trauma to the ears can lead to severe damage inside the ears including the ear drum causing tympanic membrane perforation.

Tympanic membrane perforation or ear drum rupture if left untreated, it can lead to serious complications such as:

• Hearing Loss: In most of the cases, the hearing loss is temporary and the hearing improves as the hole in the ear drum heals. Hearing loss generally affects only the ear where there is rupture of the ear drum.
• Otitis Media: Any perforation in the ear drum exposes the middle ear to the external environment making it easy for bacteria and other infectious agents to enter the middle ear. This leads to ear infection causing pain and further complications.
• Cholesteatoma as a Complication of Tympanic Membrane Perforation: As described above, rupture of the ear drum leads to exposure of the middle ear to the external environment. This can also lead to accumulation of skin cells and debris in the middle ear leading to development of a cyst called as cholesteatoma.

Diagnosis of tympanic membrane perforation is usually done by an experienced ENT specialist or an otolaryngologist. A detailed case history is obtained followed by physical examination of the affected ear. A visual inspection is done using a lighted instrument called an otoscope. In some cases, investigative tests as mentioned below are done for further evaluation and management.

• Pathological Tests: In case of fluid discharge, a laboratory test or culture may be required to determine the cause and nature of the infection if any.
• Tuning Fork Evaluation to Diagnose Tympanic Membrane Perforation: This is a chair side hearing test done using an instrument called as tuning fork evaluation. This test also helps in determining if the hearing loss is caused by damage to the middle ear, sensors or nerves of the inner ear or both.
• Tympanometry: It is a test to determine the response of ear drum to changes in air pressure using a device called as tympanometer.
• Audiology Examination: If the above listed tests do not help in reaching a conclusion, specialized series of tests called as audiology examination are conducted. It is a series of calibrated tests conducted in a sound-proof booth.

In most of the cases, Tympanic membrane perforation heals by itself within a few weeks. In certain cases, antibiotic drops may be prescribed for Tympanic membrane perforation if there is an evidence of infection. In severe cases, if Tympanic membrane perforation does not heal by itself, other treatment options as mentioned below are considered:

• Ear Drum Patch to Treat Tympanic Membrane Perforation: It is a procedure where an ENT specialist applies a chemical over the torn edges followed by placing a patch over the hole to stimulate growth and healing. This procedure may be repeated until the expected results are obtained.
• Surgical Intervention for Treating Tympanic Membrane Perforation: In severe cases of Tympanic membrane perforation, surgical intervention is warranted. The most common choice of procedure is tympanoplasty. It is a procedure where a tiny patch of own tissue is used to close the tear in the ear drum.

Conclusion

Tympanic membrane perforation is a condition characterized by rupture in the ear drum. It causes discomfort and ear and head ache along with nausea and vomiting. Tympanic membrane perforation can also lead to infection and hearing loss making it a serious condition. Hence, the condition must not be neglected and a medical advice must be taken to avoid any complication.

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