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

Treatment options include:

• watchful waiting - the perforation may heal spontaneously
  • a study was undertaken to define the characteristics of spontaneous eardrum perforation in acute otitis media (1)
    • the perforation spontaneously closed in 94 per cent of the patients within one month. The healing process was gradual and following perforation closure, there was evidence of middle ear effusion for some time before normal aeration was regained
• 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. Berger G. Nature of spontaneous tympanic membrane perforation in acute otitis media in children. J Laryngol Otol. 1989 Dec;103(12):1150-3.
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.