Tympanic membrane perforation

The ear consists of 3 parts.

1. The outer ear
2. The middle ear
3. The inner ear

The outer ear consists of external ear and ear canal. There is tympanic membrane that separates the outer ear with the middle ear in the depth of the ear canal. The middle ear is a cavity full of air located in the tympanic membrane. The air is transmitted to the middle ear from the back of the nose with the duct called Eustachian tube. The function of Eustachian tube is to equalize the pressure of air in the middle ear cavity with atmospheric pressure. Vibration created by sound waves in eardrum is transmitted to the inner ear through bones (hammer, anvil, and stirrup bones) in the middle ear cavity and awakens the signal which transmits sound into the brain. The cause of tympanic membrane is mainly trauma or infection. There can be a perforation in the eardrum as a result of fluid passing into the air, ear slap, pressure changes which is called barotrauma, skull fractures, explosion, mixing ear with cotton swab and matchstick. The middle ear infections – cause to pain, hearing loss and perforation of eardrum. In this case, there will be inflammatory and bloody discharge from the ear. This situation is the middle ear inflammation together with the eardrum perforation. It is called perforated otitis media. The main problem is the perforation in the eardrum. It shows itself with hearing difficulty, ringing, roaring, dizziness, facial nerve paralysis, and ear discharge. Rarely, there can be a permanent perforation in the ear after the ear tube placed previously to the eardrum.

Perforation in the eardrum is rapidly restored by the body. The function of eardrum is not to ensure only hearing, but also prevent microbes, dust, water passing into the ear. Microbes grow easily as a result of the impact of the water passing from perforated eardrum into the middle ear. The perforation which is not properly treated and protected can cause inflammation in the eardrum, as well as, middle ear and chronic changes related to it, hearing loss, dizziness.

If a person who has a perforation in his/ her ear doesn’t pay attention to this and live with ear discharge for years, the surgery that will be conducted can be a surgery not for improving the hearing, but only to dry the ear discharge. Therefore, if the ear cannot restore itself, in this case, it is appropriate to restore eardrum with a surgery.

Especially in children, as Eustachian tube is short than in adults, a simple flu like infection can cause the middle ear inflammation. The middle ear infection is mostly found in children who have adenoid. There is severe pain in the middle ear infection which is not properly treated and the pain is reduced in children after the eardrum is perforated and discharge comes. If the treatment is not conducted during this time, perforation in the ear remains permanently.

Eardrum perforation is restored with a surgery. If the perforation in the eardrum is not restored within six weeks, you should consult immediately otolaryngologist. The ear should be protected from water and trauma during the recovery period.

Perforation of the eardrum as a result of trauma:

If the eardrum is perforated as a result of trauma and there is no any infection, it is restored by itself in most cases. However, otolaryngologist may do simple interventions for this recovery to be accurate and speedy. Perforation which is not recovered by itself need surgery.

How should the eardrum be protected?

• You should consult doctor at the moment of hearing loss. The ear shouldn’t be cleaned with cotton swab or any other external body. Soldiers and miners who shoot a gun or work with explosives should wear ear - flaps.
• If your eardrum is perforated, you should protect your ear from water. While taking a shower or washing your head, you should put a cotton with Vaseline. Ear plugs can also be used.
• If there is ear discharge, medicine should be taken. You should put cotton in order to determine whether there is discharge or not.
• The drug treatment is used when there is ear discharge. Drops or powders are used. It may be needed in some people to take antibiotic orally.

How is the eardrum restored?

If the perforation is small, your doctor may control whether it is closed or not or makes some small interventions. For this purpose, patch can be made by putting medicine on the edges of the perforation under microscope and closing the eardrum with a thin paper. If it is larger, operations which are called Myringoplasty or Tympanoplasty can be performed. Mainly, temporal muscle fascia or cartilage taken from helix is used for the purposes of patch.