Perforation of the tympanic membrane

Perforation of the tympanic membrane produces a conductive hearing loss in the affected ear.

Causes include:

• infection
  • purulent acute otitis media with tympanic membrane perforation
  • chronic otitis media with tympanic membrane perforation
• trauma
  • to the tympanic membrane
  • to the temporal bone
• iatrogenic - myringotomy with tympanostomy tube placement

Although many TMPs heal spontaneously, patients often require management of hearing loss and mitigation of infection risk during the healing period. (1)

Treatment options include:

• watchful waiting - the perforation may heal spontaneously
• myringoplasty (tympanoplasty) - repair of persistent tympanic membrane perforation

Notes:

• tympanostomy tube placement (2):
  • tubes retained for longer than 30 months are unlikely to spontaneously extrude and that tubes retained for longer than 24 months have a higher rate of residual perforation
  • if a tube requires removal then there is a higher rate of perforation as compared with those spontaneously extruding

Reference:

1. Hanege FM, Karaca S, Kalcioglu MT, Tekin M. Comparing Spontaneous Closure and Paper Patching in Traumatic Tympanic Membrane Perforations. J Craniofac Surg. 2018 Oct;29(7):1922-1924
2. Schraff SA et al. Outcomes in children with perforated tympanic membranes after tympanostomy tube placement: results using a pilot treatment algorithm. Am J Otolaryngol. 2006 Jul-Aug;27(4):238-43.