What is eardrum perforation?

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Perforation of the eardrum: causes, symptoms and treatment

Perforation of the eardrum is a fairly common occurrence, especially when it comes to inflammation or injury to the ear. The symptoms of membrane rupture are familiar to many, but not everyone knows how to deal with the problem.

Table of contents:

When damage of any kind occurs in the ear, it can have negative consequences, so it is important to properly treat it. In some cases, plastic surgery may even be necessary. Let's consider this issue in more detail.

Causes and consequences

What is perforation? Essentially, it is a small hole that occurs in the eardrum. Violation of the membrane impermeability can be either spontaneous or forced, for example, in the treatment of purulent otitis, when paracentesis is performed to remove secretions. A thin membrane divides the ear into the outer and middle, so such interventions affect its functions and general condition.

Various reasons can lead to a rupture. Basically, they have an inflammatory or traumatic nature of occurrence.

  • Adhesive otitis media. This is a dry lesion, so its symptoms are not as obvious as with other types of otitis media. In this case, a pressure drop occurs, the inflamed ear becomes covered from the inside with scars, which lead to perforation.
  • Purulent otitis. In acute inflammation, exudate accumulates, which then turns into pus and puts pressure on the membrane, thinning it. Damage to the eardrum is easy to notice here, as signs of suppuration occur. In the chronic form of the disease, persistent perforation is observed. The consequences of this otitis are expressed in membrane necrosis.
  • Mechanical injury. Any injury can damage the integrity of the eardrum, for example, due to improper cleaning of the ear canal or a foreign object, which can easily happen to a child. Plastic surgery or other medical manipulation can also damage it.
  • Barotrauma. Sudden changes in pressure, blast wave, flying in an airplane, diving. When external pressure is applied, retraction and further perforation of the eardrum occurs. An ear injury during sports or a simple clap of the palm of the hand on the auricle can lead to this result. Retraction provokes eustachitis and other diseases. Protrusion of the membrane may also be observed.
  • Post-traumatic damage. A ruptured eardrum can occur from a blow to the head. These are the consequences of traumatic brain injuries with fractures of the bones of the skull, ears, jaw, etc. Treatment is long and complex.
  • Acoustic impact. Damage to the eardrum occurs due to excessively loud sound. A sharp vibration of the membrane and auditory ossicles leads to their overstrain and injury.

Some causes are quite easy to eliminate or at least limit their impact. For inflammation, special drops are used to destroy microbes and reduce pressure on the membrane. Injuries should simply be avoided, which will allow you to maintain overall health.

The consequences of a rupture depend on the circumstances of its occurrence and further measures taken. The following scenarios are possible:

  • Healing. The membrane heals on its own, and after a few weeks there will be no trace of the rupture. Minor scarring may occur on the surface, but this does not affect the functioning of the ear. For disinfection, the doctor will prescribe special ear drops.
  • Necrosis. If an infection occurs that takes a protracted form, extensive perforation is observed. Here there is a risk of suppuration and death of membrane tissue with transition to bone formations.
  • Infection. If the injury was caused from the outside, an infection can be introduced through the damaged area into the middle ear cavity. The result is external and otitis media, myringitis.
  • Labyrinthitis. If the inflammation spreads further into the inner ear, a serious disease develops - labyrinthitis.
  • Mastoiditis. Inflammation of the mastoid process of the temporal bone of the middle ear.
  • Cholesteatoma. This is an ear cyst that forms from epithelial growths along the edges of the tear.
  • Conductive hearing loss. There is a risk of deafness due to dysfunction of the sound-conducting chain in the ear that was injured.
  • Facial nerve paresis. The ear contains branches of nerve endings, including access to the facial nerve.
  • Intracranial complications. These are abscesses, meningitis and other complications affecting the brain.

Symptoms and diagnosis

Perforation of the eardrum cannot occur unnoticed. After a rupture, severe discomfort occurs in the ear. Symptoms that a person’s eardrum has burst include the following:

If the eardrum ruptures during purulent otitis, the patient’s condition is relieved, as the pressure of the secretions on the soft tissues decreases, and part of the pus flows out.

To reliably find out whether the eardrum is damaged, you need to contact an otolaryngologist. The doctor will determine the extent and cause of the perforation and prescribe drops and tablets to restore the integrity of the ear.

Diagnostics is as follows:

  • Otoscopy. Examination of the ear using an otoscope. A perforation of the eardrum itself, signs of the development of otitis media and other prerequisites and consequences of damage are detected.
  • Otomicroscopy. It is carried out to examine the ear in more detail and find out additional signs of the presence of perforation of the eardrum, its severity and the nuances of the problem.
  • Audiometry. Since disruption of the integrity of the eardrum is associated with hearing impairment, these symptoms can be confirmed by studying the sensitivity of sound perception. Special studies of sound potentials are carried out for the child.
  • Impedancemetry. The ear is examined using computer tests.
  • Tympanometry. After ear injury, it is necessary to check the sensitivity of the membrane.
  • Tuning fork tests. The ear has the ability to conduct bone conduction of sound.

If the provoking factor was injury, additional examinations may be needed: radiography, CT, MRI.

After identifying the severity of the problem and the factors that provoked it, a special course of treatment is prescribed. This may include ear and nasal drops, plastic surgery, physiotherapy, etc. It is important to take care of the sore ear until complete recovery.

Treatment methods

Since a ruptured eardrum can lead to complications, it is important to return it to its normal appearance as soon as possible. Restoration of the health and integrity of the eardrum, in the absence of complications, occurs independently. Within 2-3 weeks it completely heals and restores its functions. To speed up this process, auxiliary treatment of eardrum perforation is prescribed. But if healing does not occur for a long time, plastic surgery may be necessary.

Therapy consists of a set of measures. The first stage is drug treatment. Since the symptoms of injury are accompanied by discomfort and pain, analgesics and anti-inflammatory drugs can be used to relieve them. Regular ear drops are recommended to be applied in the form of turundas. Antibacterial drops and antibiotics are used only under the supervision of a doctor, since the ear has internal damage. It is important to get rid of otitis media and prevent tissue inflammation.

The second stage is ear protection. It is important for a child to prevent water penetration when bathing, as the consequences can manifest themselves in the form of acute inflammation. Use a cotton plug and gently clean the ear canal of any secretions.

Dry perforation of the eardrum is treated by blowing to restore pressure in the ear.

Physiotherapy procedures include pneumomassage, UHF, blue lamp, and electrophoresis. Thanks to them, scarring of the eardrum after perforation is reduced, and the drops penetrate better into the tissue.

You also need to know what not to do if the eardrum has burst, namely: it is not recommended to warm the ear, especially when it is suppurating, to wet it and clean it with cotton swabs. Using medicinal drops without a doctor's permission is also prohibited. The consequences of unauthorized use of alcohol medications are middle ear burns and intoxication of the body.

Ear restoration is possible with myringoplasty. This is an operation to reconstruct the eardrum. This type of plastic surgery allows you to close even a large perforation and eliminate the consequences of chronic tympanitis. If an injury has been caused to the auditory ossicles, a parallel operation is performed to restore them. A skin flap is grafted in place of the membrane. Drops and ointments are used for healing. Treatment takes place in a hospital.

If the causes of the perforation lie in purulent otitis, shunting and sanitation of the cavity can be used to eliminate the pus. Medicines are injected into the ear, and only then the membrane is repaired.

Try to protect the ear from damage and inflammation to prevent destruction of its elements and hearing loss.

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Source: http://bezotita.ru/ushnye-zabolevaniya/perforaciya-barabannoj-pereponki.html

Perforation of the eardrum due to otitis media

The eardrum is a thin layer of skin folded into a funnel shape that separates the ear canal. Perforation of the eardrum means the formation of any hole or rupture in this place. This education is extremely necessary for the implementation of auditory functions. Without an eardrum, the functioning of the hearing organs is impaired, because it is involved in the transmission of sound and transmits air vibrations to the hammer. After this, the vibrations are transmitted to the auditory ossicles and to the inner ear. Perforation of the membrane leads to impaired perception of sounds; they may not be perceived clearly or not at all.

It is important to remember that in addition to responsibility for the quality of sound perception, the eardrum has another function - protecting the middle and inner ear from infections. When a hole is formed, pathogenic microorganisms can freely penetrate into the middle ear cavity, and this leads to an inflammatory process.

Causes of perforation

A perforation is the formation of a small hole in the eardrum. Violation of the integrity of the overlap can occur spontaneously, but at the same time it can be a necessary measure for the treatment of purulent otitis. Forced surgery is performed if it is necessary to cleanse the ear cavity from accumulated purulent exudate. Such a membrane separates the middle and outer ears, so violations of its integrity affect the quality of hearing.

Rupture of the membrane can be caused by several reasons; as a rule, it occurs as a result of injury or an inflammatory process.

  1. With adhesive otitis media, a pressure drop often occurs, against the background of which the inner surfaces of the ear become covered with scars. Despite the fact that adhesive otitis media is a dry lesion, perforation is often diagnosed.
  2. With purulent otitis, an accumulation of purulent contents occurs, pressing on the membrane, against the background of which thinning occurs. Damage to the eardrum with this type of otitis is easy to notice, since there are signs of suppuration. Chronicity of the process is extremely dangerous, because against such an unfavorable background, persistent perforation appears, and necrosis of the tympanic membrane is often diagnosed.
  3. Traumatic perforation of the eardrum is the result of negative mechanical impact. This often occurs due to improper cleaning of the ear canal. Perforation in children may be the result of a foreign body inserting into the ear canal.
  4. Injury can occur as a result of pressure surges, blast waves, flying in an airplane, or diving. As pressure increases, retraction occurs, which causes perforation. This injury can be caused by a slap on the ear.
  5. Post-traumatic perforation of the eardrum can occur due to head injuries, fractures of the skull and jaw.
  6. Damage can occur if the acoustic impact is too strong. Sharp and strong vibrations lead to tension and injury to the auditory ossicles.

Treatment of perforation takes a long time. If you suspect damage of this kind, you should immediately contact a specialist. Only timely assistance will be the key to a full recovery with absolute restoration of hearing functions.

Possible complications

Limiting the influence of negative factors is quite simple. For inflammation, drops are used that kill pathogenic microorganisms and reduce pressure on the eardrum.

The consequences of a membrane rupture depend on the nature of the injury and related factors. It all depends on the measures taken. Possible scenarios include:

  1. Healing. This is a completely natural process; damaged membranes heal on their own after some time (about 2 weeks), leaving no trace of the rupture. Small scars form on the surface, which in most cases do not affect the quality of sound perception. It is important to note the need to use disinfectant solutions during this period. Only an otolaryngologist can select the most effective drug. Therefore, you should not self-medicate.
  2. Necrosis occurs with prolonged infection and extensive perforation occurs. There is a high risk of suppuration and death of the membranes. The process may affect bone formations.
  3. It is possible that myringitis may develop as a result of infection from outside.
  4. Labyrinthitis, as a rule, develops in the absence of proper treatment if the inflammation spreads to the cavity of the inner ear.
  5. Damage to the facial nerve. Nerve endings pass through the ear, including the exit to the facial nerve.
  6. The development of mastoiditis is possible.
  7. Formation of a cyst from epithelial growths at the edges of the tear.
  8. Development of conductive hearing loss.
  9. A dangerous consequence is intracranial complications such as meningitis.

Characteristic symptoms

The symptoms of a perforated eardrum cannot be ignored. Firstly, acute pain appears. Within 2-3 days after the injury, the pain will be quite severe, after approximately 5-7 days it will pass. It is important to note that in the presence of a purulent inflammatory process of the middle ear, the patient feels pain, but after the membrane ruptures, on the contrary, it subsides.

Among a number of symptoms of perforation are:

  • feeling of sharp pain inside the ear;
  • discharge of pus from the ear opening;
  • the presence of bloody discharge (possibly due to acoustic trauma);
  • decreased hearing acuity.

It is worth remembering that if the cause of the perforation is an infectious process, there is the possibility of complete hearing loss.

Hearing should be restored completely after the hole heals. It is important to note that it is very difficult to determine clear terms for overgrowth; it all depends on the size of the hole and aggravating factors. If the perforation occurs as a result of a complex head injury, the patient may completely lose hearing forever. Inflammatory processes in the ear area must be treated very carefully and timely treatment must begin; delay in this case often becomes the cause of the development of chronic otitis media and absolute hearing loss.

Diagnostic measures

Diagnostic measures include:

  1. Otoscopic examination. Perforations of the eardrum and signs of otitis media can be detected by an otolaryngologist during an examination.
  2. Otomicroscopy allows you to determine the severity of perforation and determine previously undetected nuances of pathology.
  3. Audiometry allows you to determine the sensitivity of the hearing organs to sounds.
  4. Tympanometry allows you to directly determine the sensitivity of the eardrum.
  5. A number of computer tests are carried out - impedance measurements.

Computed tomography and magnetic resonance imaging are often used when the perforation of the eardrum is caused by trauma. After identifying the cause of the perforation, a special course of therapy is selected. For treatment, conservative methods are more often used: physiotherapy and medications, and hearing surgery is performed in extreme cases. Responsibility for the outcome of treatment falls entirely on the shoulders of the patient himself; it is extremely important to protect the injured ear from external factors until complete recovery.

Treatment methods

Perforation of the eardrum in most cases does not require special treatment. If the hole occupies no more than 25% of the total membrane area, complications do not arise. The patient must follow the doctor's recommendations regarding cavity protection; it is important to limit hygiene procedures during the treatment period.

If the perforation is small, the doctor uses a paper patch, and before applying it, treats the edges with a solution that stimulates cell growth. The manipulation is repeated 3-4 times.

An otoscopic examination may reveal particles of dirt or blood in the cavity, then the doctor removes them with a cotton swab and treats the cavity with a disinfectant. Broad-spectrum antibiotics are often used to prevent the spread of infection. If the cause of perforation is complex otitis, a full course of treatment is carried out.

If the affected area is quite extensive and drug therapy does not produce results, surgical intervention is resorted to. Myringoplasty is performed under general anesthesia. A small incision is made above the ear to collect a flap of skin necessary for stitching the membranes. The operation is performed using an endoscope, which is inserted into the ear canal. The edges of the fabrics are sewn together using self-absorbing threads. The sutures hold the patch securely, which ensures speedy healing.

There is no point in trying to heal the perforation using folk remedies. They are not able to replace full-fledged treatment, and in some cases they can cause a deterioration in the patient’s well-being. It is also not recommended to use medications or treat the ear cavity with disinfectant solutions without a doctor’s prescription.

Prevention of eardrum perforation

It is possible to prevent perforation of the eardrum.

  • Hearing protection should be provided against exposure to loud noise.
  • It is necessary to carefully clean the ears from the accumulation of wax, since perforation of the eardrum is often caused by mechanical damage.
  • You should not self-medicate otitis media - this pathology is one of the most common causes of perforation.

Much depends on the patient’s attitude towards his own health. The manifestation of constant tinnitus and pain in the cavity is a reason to visit an otolaryngologist. If otitis media is not treated in a timely manner, a rapid accumulation of pathogenic contents occurs.

Source: http://gaimorit-sl.ru/otit/perforaciya-barabannoi-pereponki.html

Symptoms and treatment of perforation of the eardrum

If the eardrum is perforated, the person feels severe pain in the damaged ear and the vibration of all sounds is disrupted, causing hearing problems. Ear perforation is especially dangerous because the resulting hole allows microbes to enter the middle ear canal, which is why otitis media often begins. With such a pathology, it is very important not only to quickly detect the problem, but also to correctly prescribe treatment. The speed of recovery and the absence of complications will depend on this.

Causes of membrane perforation

Perforation of the eardrum is a complete or partial violation of the integrity of a special membrane made of skin, which acts as a barrier between the ear canal and the middle ear. The eardrum mainly performs a special protective function; in addition, it takes part in the transmission of sounds. Perforation of the eardrum can occur in a number of cases; the main causes of this pathology are:

  • Prolonged inflammation in the ears. In this case, pus accumulates in the ear canal, the outflow of which is completely or partially disrupted. Due to this, pressure occurs on the skin membrane and as a result it can be completely destroyed by pus. Chronic otitis with further perforation of the eardrum occurs if the inflammatory process is not treated for a long time.
  • Perforation of the skin membrane in the ear can occur due to pressure. This is observed if a person sneezes, covering his nose, dives sharply under water, and also when flying on an airplane.
  • A blast wave or any loud sound can cause eardrum perforation and hearing loss.
  • Mechanical injury. This happens if a person cleans their ears with sharp objects - hairpins, paper clips or matches.
  • At elevated temperatures, thermal damage may occur. This is often observed in people who work in metallurgy or are engaged in blacksmithing.
  • If foreign objects get into the ear. This often happens in small children or adults who actively clean the ear canals with special cotton swabs.

In addition, perforation of the eardrum can occur as a result of cranial trauma, especially when there is damage to the temporal bones.

Any violation of the integrity of the eardrum requires urgent treatment, otherwise there may be serious complications that will ultimately lead to hearing loss.

Main symptoms of membrane damage

Damage to the membrane is accompanied by symptoms such as severe ear pain and congestion. However, after a few hours, the pain subsides and the patient develops the following signs of perforation of the eardrum:

  • feeling of regular ringing in the ears;
  • separation of colorless liquid or thick pus from the ear canal, especially if the perforation is caused by chronic otitis media;
  • when ruptured by a sharp object, discharge of blood or ichor is observed;
  • The victim complains that his hearing has deteriorated significantly.

In the case when the injury is too deep and the inner ear is affected, the person complains of constant dizziness. If there is a complete rupture of the membrane, then when you cough or strongly blow your nose, air is released from the damaged ear.

The severity of all signs of the disease directly depends on the extent of the damage. So, if the hole in the eardrum is small, then the pain goes away quite quickly and only a slight decrease in hearing remains.

If the damage is very severe, the painful process can spread to the entire inner ear. If the integrity of the ear membrane is violated, as well as with the further addition of a bacterial infection, various complications can be observed:

When pathogenic microbes penetrate deep-lying tissues, meningitis or encephalitis may begin. These are very dangerous diseases that lead to severe brain damage.

If the hole in the eardrum is too large, it can lead to complete hearing loss!

Treatment options

About half of all eardrum injuries do not require treatment. The perforated membrane completely heals itself within 3-4 weeks, and damage that covers no more than 25% of the membrane area heals most quickly. In this case, it is enough for the victim to follow a daily routine and avoid any hygienic procedures in the ear canal.

Treatment with medications

If the hole in the ear is small, the doctor uses special paper to cover it, and a so-called patch is applied to the membrane. The doctor must treat the edges of the hole with a product that stimulates skin growth. Usually up to four treatments are enough for the hole to completely close.

When, during examination, blood clots or contaminants are found in the ear canal, the doctor carefully removes them with a cotton swab, then treats the walls of the ear canal with medical alcohol and inserts a dry cotton swab.

For small holes in the membrane, various cauterizing agents can be used - chromic acid or silver nitrate; damaged edges are treated with such substances

To prevent infection, treatment with antibacterial drugs may be prescribed. If acute otitis is diagnosed, then complex treatment of this disease using both local drugs and antibiotics is indicated.

Surgical treatment

In cases where the membrane rupture is too extensive or conservative treatment is of no use, surgical intervention is indicated. This operation is called myringoplasty.

The surgeon cuts a miniature piece of skin behind the ear and uses it to stitch the hole in the membrane. This operation is performed using a special endoscope that is inserted deep into the ear canal. This is a very painstaking work that requires extreme caution and accuracy from the surgeon. A flap of skin taken from behind the ear is sewn to the membrane with catgut.

Sutures securely secure such a patch until the eardrum completely heals. The threads dissolve within a few weeks; this is the time required for complete restoration of the membrane. During the healing period, a tampon moistened with an antibacterial agent is placed in the ear canal; such tampons are recommended to be changed according to the doctor's instructions.

Immediately after the operation, the patient may complain of severe pain and general discomfort in the ear, but usually within a few days all these unpleasant phenomena disappear without a trace. For several weeks, it is advisable not to blow your nose too much or take sharp breaths through your nose in order to limit the pressure on the inflamed membrane. If you do not follow the doctor's recommendations, the skin flap may move to the side, which will complicate its healing.

The operation to restore the integrity of the eardrum is performed under general anesthesia.

Is it possible to use traditional methods of treatment?

Quite often, people with a perforated eardrum resort to traditional medicine. It’s worth saying right away that any recipes from traditional healers will not be able to replace traditional medicine in this case and greatly speed up the healing of the membrane, so before starting such treatment you should consult a doctor.

To speed up the healing process, during the entire treatment period it is recommended to consume more products that are rich in ascorbic acid - this is rosehip decoction, citrus fruits, blackcurrant jam, sauerkraut or hawthorn decoction. In addition, it is advisable for the patient to eat sweet grapes or dried fruits - raisins and dried apricots.

You can put cotton wool into the ear canal, which is moistened with plantain juice, tincture of nightshade leaves or pine needles. To prepare such medicinal tinctures, take 2 full tablespoons of crushed plant material and pour in 100 ml of alcohol. Then leave for several days in a dark place.

A hole in the eardrum may persist for a long time after the main symptoms have disappeared. It is very important that the doctor constantly monitors the healing process. This will help avoid dangerous consequences such as hearing loss or the disease becoming chronic.

It is strictly forbidden to use any folk remedies for membrane perforation in young children, especially without a doctor’s recommendation!

Medicines

When treating a perforated eardrum, topical medications are almost always prescribed, in this case ear drops. Such drugs perform the following function:

  • help reduce inflammation in the ear;
  • accelerate the healing of damaged membranes;
  • quickly relieve acute pain;
  • prevent the addition of a bacterial infection.

If the eardrum is damaged, the patient is prescribed drops that contain broad-spectrum antibiotics or steroids. The main medications that can be prescribed for damage to the eardrum can be identified as follows:

  1. Otipax - these drops mainly relieve pain. They contain lidocaine and a steroid that has an anti-inflammatory effect. In case of acute inflammation of the middle ear, such drops alone will not be enough.
  2. Otofa - this drug is a broad-spectrum antibiotic. Quite effective ear drops in the treatment of membrane perforation. But this drug does not relieve pain, and is also contraindicated during pregnancy and breastfeeding.
  3. Sofradex - this drug is prescribed only in exceptional cases. Neomycin, which is part of the drug, gets into the middle ear and can have a toxic effect at the cellular level.
  4. Candibiotic is a complex drug that contains antibiotics of different medicinal groups and an antifungal agent. In some patients it causes intolerance in the form of allergies, so a sensitivity test must be performed before treatment.

In addition, Amoxicillin or Augmentin may be prescribed. Treatment with such antibacterial drugs should last at least a week. The duration of therapy is usually determined by the doctor individually.

During treatment, it is very important to strictly follow all the doctor’s recommendations, then recovery will be quick, without any complications.

Prevention of membrane perforation

To prevent eardrum rupture, you need to follow simple recommendations:

  1. Do not clean your ears with sharp objects;
  2. You cannot stay for a long time without personal protective equipment in rooms with strong noise.
  3. When the plane takes off, you should wear special headphones or suck on the hard candy.
  4. You should not fly on an airplane during an exacerbation of pathologies of the ENT organs, as well as allergies.
  5. Treat any inflammatory ear diseases in a timely manner.

Particular attention should be paid to preventive conversations with children about preventing self-cleaning of their ears. If there are young children in the house, then cotton swabs and other similar items should be stored out of their reach.

When cleaning the ear canals, you need to use a cotton swab, but you should not push it too far into the ear.

In many cases, a damaged eardrum heals well on its own, without specific treatment. In this case, the main thing is to diagnose the pathology in a timely manner and prevent the addition of a bacterial infection. In severe cases, surgical treatment and broad-spectrum antibiotics may be indicated. Therapy should be prescribed by an ENT doctor after a thorough examination of the ear canal.

Source: http://pulmono.ru/uho/drugie2/simptomy-i-lechenie-perforatsii-barabannoj-pereponki

Perforation of the eardrum: symptoms and treatment

Perforation of the eardrum - main symptoms:

  • Noise in ears
  • Dizziness
  • Fever
  • Sleep disturbance
  • Nausea
  • Loss of appetite
  • Tinnitus
  • Loss of consciousness
  • Ear congestion
  • Earache
  • Disorientation
  • Hearing loss
  • Purulent discharge from the ear
  • Deafness
  • Air coming out of the ear
  • Bloody discharge from the ear

Rupture or perforation of the eardrum is damage to the membrane due to exposure to a large number of unfavorable factors. Under the influence of mechanical, physical, chemical or thermal reasons, a gap is formed, which disrupts a person’s ability to fully hear sounds. Sometimes self-recovery of the membrane is observed, but only with minor damage. With more severe trauma, a scar may remain, and in particularly severe situations, any violation of integrity can lead to hearing loss.

There are quite a few predisposing factors that can lead to such a disorder. All of them can be divided into several groups. But the most common factors for damage to the membrane are inflammation in the middle ear, exposure to pressure, sudden and unexpected noise, injury while cleaning the ear with objects not intended for this purpose, the pathological influence of hot liquids both at home and at work, as well as penetration foreign objects into the ear.

Any violation of the integrity of the eardrum is accompanied by the manifestation of unpleasant symptoms. Symptoms of a ruptured eardrum are pain of varying intensity and character, a feeling of fullness in the damaged ear, the occurrence of tinnitus, decreased hearing, up to its complete loss.

Diagnosis of such a disorder involves performing a series of instrumental examinations. When discharge appears, a laboratory study of the contents is carried out. Treatment for perforation of the eardrum consists of using medications or performing medical plastic surgery. The choice of therapy method is based on the volume of damage.

Etiology

As mentioned above, a ruptured eardrum can occur from a large number of causes, which are divided into several groups. The first group consists of mechanical factors, which include:

  • wide range of ear injuries;
  • accidental or intentional penetration of a foreign object into the ear cavity;
  • unqualified performance of medical procedures aimed at removing the ear plug;
  • cleaning the ear with objects not intended for this process;
  • traumatic brain injuries.

Physical damage can occur when:

  • pressure difference in this area. This can happen due to severe coughing or sneezing, as well as temperature changes during airplane flights or diving;
  • falling on the ear;
  • strong blows to the ear;
  • unexpected noise.

The last group of factors is thermal, which can lead to perforation of the eardrum, including:

  • ear burns. They can be of a domestic or industrial nature;
  • toxic or chemical substances entering the ear.

A little-known group of injuries is military, which includes shrapnel and bullet wounds.

In addition, diseases can become factors in the formation of such a disorder. In particular, such as acute otitis media or chronic purulent otitis media. Certain factors can lead to either minor trauma to the membrane or its complete destruction.

Symptoms

Immediately after the rupture of the eardrum, a pronounced pain syndrome appears, which passes after some time or other symptoms appear against its background. The following clinical manifestations come to the fore:

  • the appearance of noise and ringing in the ears;
  • a feeling of discomfort in the form of ear congestion;
  • the occurrence of bloody or purulent discharge, often with an unpleasant odor;
  • partial decrease or complete loss of hearing;
  • increased body temperature;
  • attacks of nausea and dizziness;
  • disorientation;
  • decreased appetite;
  • sleep disorders;
  • perforation;
  • episodes of loss of consciousness;
  • the release of air from the auricle indicates a completely perforated membrane.

The severity of symptoms of eardrum perforation depends on the intensity of the lesion. Minor trauma, affecting only the outer layer and a small part of the middle layer, does not entail hearing loss or the appearance of other signs. Moreover, such damage can be eliminated on its own, which is observed in almost half of the patients. Severe damage is often accompanied by fractures of the auditory ossicles or injury to the internal muscles. With such a lesion, intense expression of symptoms is observed.

Complications

If you ignore the symptoms, as well as if you provide unqualified or incomplete therapy, the consequences of a ruptured eardrum may occur. These include:

  • spread of the inflammatory process to the entire area of ​​the inner ear;
  • feeling of some unpleasant symptoms in the healthy ear;
  • nerve neuritis;
  • otitis;
  • labyrinthitis;
  • meningitis and encephalitis - develop only when pathological microorganisms enter the affected area;
  • temporary memory loss;
  • discharge of cerebrospinal fluid from the ear opening - in cases where the cause of the lesion was a traumatic brain injury;
  • structural disorders of some elements of the auricle.

If the tear is large, complete hearing loss may occur.

Diagnostics

An ENT doctor knows what perforation of the eardrum is - it is this specialist who carries out the diagnosis and prescribes treatment tactics. Before conducting instrumental and laboratory examinations, the doctor must perform several manipulations. In particular, get acquainted with the patient’s medical history and life history. This is necessary to find the causes of the disease. Palpation and careful examination of the affected area using special instruments is also necessary. This will enable the doctor to determine the extent of the eardrum rupture, as well as identify the presence and intensity of symptoms.

Instrumental diagnostic methods include:

  • otoscopy – study of the affected area and ear canal, search for membrane deformations. It is carried out using special devices from an otolaryngologist - an ear specula, an otoscope and a frontal reflector;
  • CT is a way to fully visualize all layers of the ear;
  • audiometry is a procedure for studying hearing acuity. Allows the doctor to determine the degree of hearing loss or diagnose complete hearing loss.

Laboratory tests consist of performing a general blood test, as well as a microscopic examination of purulent or mucous fluid secreted from the auricle.

Treatment

After a ruptured eardrum, it is necessary to transport the victim to a medical facility as soon as possible. Before this, you cannot provide first aid yourself. In particular, apply cold to the affected ear, rinse it, and remove blood clots or purulent fluid. The only thing you can do on your own is to put dry cotton wool in the damaged ear and bandage it. For severe pain, painkillers can be given.

Professional treatment of eardrum perforation consists of several manipulations:

  • elimination of bleeding;
  • cauterization - used only for minor ruptures;
  • promoting the free outflow of purulent or mucous fluid;
  • infusion of antimicrobial drugs into the ear cavity using a catheter;
  • installing a patch – used to repair only minor damage to the membrane.

Drug therapy consists of prescribing:

  • a course of antibiotics - in the form of ear drops or tablets;
  • vasoconstrictor drugs;
  • mucolytics;
  • anti-inflammatory drops.

In particularly severe situations, when the eardrum is perforated, surgical intervention is resorted to. This is necessary in cases:

  • complete rupture of the membrane;
  • partial hearing loss;
  • impaired mobility of the auditory ossicles.

There are several ways to treat this disorder with surgery. For this purpose they can assign:

  • myringoplasty - the intervention consists of replacing the membrane with a flap taken from the temporal muscle. Sutures are applied with threads, which dissolve on their own after a few weeks;
  • ossiculoplasty is an operation to restore the auditory ossicles, often with their prosthetics. The procedure is carried out only under local anesthetic;
  • tympanoplasty – removal or implantation of artificial auditory ossicles.

Often, traditional medicine is used in treatment, which should be used only after consulting a specialist. They promote rapid healing.

Prevention

To prevent a person from having problems with a ruptured eardrum, it is necessary to adhere to several rules:

  • clean your ears only with cotton swabs intended for this purpose;
  • ensure that foreign objects do not enter the ear, especially in children, and do not remove them yourself;
  • avoid exposure to strong noise;
  • do not fly on airplanes or dive into deep water during exacerbations of ear diseases;
  • When the first symptoms occur or fluid comes out of the ear, you should immediately contact a specialist.

The prognosis of the disease directly depends on the degree of membrane rupture. With minor damage, spontaneous healing occurs in half of the patients. An unfavorable outcome occurs as complications progress, as well as in cases of damage to the auditory ossicles or bacterial infection. This can lead to complete loss of hearing, which, in turn, requires surgery to restore it or the installation of a hearing aid.

If you think that you have a perforation of the eardrum and the symptoms characteristic of this disease, then an otolaryngologist can help you.

We also suggest using our online disease diagnostic service, which selects probable diseases based on the entered symptoms.

Otitis in a child is considered the most common pathology among this age category, affecting all structures of the auditory canal. Experts in the field of pediatric otolaryngology claim that by the age of 7, approximately 95% of children suffer from this disease.

Chronic otitis is an inflammatory disease of the middle ear, which is characterized by the formation of a hole in the eardrum with constant or recurrent discharge of pus from the auricle.

Acoustic neuritis is a disease of the nervous system characterized by the manifestation of an inflammatory process in the nerve that provides auditory function. In the medical literature, this disease is also called “cochlear neuritis.” Typically, this pathology is diagnosed in older people over 50 years of age (more often in the stronger sex). Such people rarely seek help from a qualified specialist, considering the decline in hearing function to be a normal process that accompanies the aging of the body.

A complex of symptoms indicating a violation of cerebral circulation that occurs against the background of compression of one or more blood arteries through which blood flows to the brain is vertebral artery syndrome. The disease was first described back in 1925 by famous French doctors who studied the symptoms accompanying cervical osteochondrosis. Then it occurred mainly in elderly patients, but today the disease has become “younger” and its symptoms are increasingly found in 30, and sometimes 20-year-old young people.

Purulent otitis is a common otorhinolaryngological pathology, which is characterized by inflammation of the epithelium lining the surface of the inner and middle ear. As a result, purulent exudate appears in the ear cavity.

With the help of exercise and abstinence, most people can do without medicine.

Symptoms and treatment of human diseases

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Source: http://simptomer.ru/bolezni/otolaringologiya/2121-perforatsiya-barabannoj-pereponki-simptomy

Perforation of the eardrum

Perforation of the eardrum means a violation of the impermeability of the elastic membrane separating the outer and middle ear (membrana tympani), which ensures the perception and amplification of external sound waves.

Damage to this vital part of the sound-conducting apparatus, accompanied by loss of its integrity, is also called a rupture, although it may simply be a small through hole. However, this does not change the essence of the pathology.

Causes of eardrum perforation

In otolaryngology, depending on the cause of the damage, it is customary to distinguish between perforations of the tympanic septum of an inflammatory and traumatic nature.

Traumatic perforation of the eardrum occurs when it is accidentally mechanically damaged during the process of cleansing the ear canal using matches with cotton wool (or cotton swabs) or when trying to scratch an itchy ear with improvised objects. Careless medical manipulations can have the same consequences. Often, perforation of the eardrum in a child occurs when a foreign body is removed from the ear.

When the external air pressure on the membrane sharply increases, it bends strongly towards the middle ear cavity and, unable to withstand compression, bursts. This can happen during air travel - when the plane is gaining altitude during takeoff or descending before landing. You can damage the membrane as a result of barotrauma by jumping into water or diving deeply into it (during scuba diving, in violation of diving and caisson safety precautions), receiving a blow to the ear that increases compression on the membrane (for example, in boxing such an injury is caused by a blow with an open glove along the auricle).

In the case of a short-term vibroacoustic impact on the membrane of sounds with a volume above dB (gunshot, explosion, etc.), acoustic perforation occurs. Post-traumatic perforation of the tympanic membrane is often observed with fractures of the base of the skull or temporal bone.

The cause of inflammatory perforation of the tympal membrane is acute purulent otitis media. The main causative factor for perforation of the eardrum in a child with otitis is the accumulation of purulent exudate in the tympanic cavity. On the one hand, this causes necrosis of the tissue of the membrane itself, and, on the other, a large volume of purulent mass accumulated in the cavity, pressing on the membrane, leads to its breakthrough. Until now, a rupture of the eardrum with suppuration is considered as the second stage of acute purulent inflammation of the middle ear.

As otiatrists note, chronic purulent inflammation of the middle ear is almost universally accompanied by persistent perforation of the eardrum: in the center of the eardrum (mesotympanic), in its upper part (epitympanic) or in both parts at once (epimesotympanic).

And dry perforation of the eardrum - with a significant decrease in hearing acuity - is detected after acute catarrhal otitis or chronic purulent inflammation of the middle ear, as well as as a consequence of cicatricial (adhesive) otitis.

Symptoms of eardrum perforation

Experts identify such typical signs of a traumatic membrane rupture as: acute pain in the ear, bloody discharge from the ear canal, tinnitus (tinnitus), dizziness, severe hearing loss (partial hearing loss).

Clinical practice shows that the location of membrane damage determines the degree of hearing impairment and its pathogenesis. So, when perforation affects the edges of the eardrum, a person experiences conductive hearing impairment - a decrease in auditory conductivity due to poor propagation of sound waves. In cases of acoustic injuries to the eardrum, irreversible sensorineural hearing loss associated with functional disorders of the receptor apparatus of the auditory analyzer located in the inner ear cannot be excluded.

When listing the main symptoms of perforation of the eardrum of inflammatory etiology, doctors name: discharge of watery exudate from the ear, otorrhea (discharge of pus from the ear), rapid decrease in pain, tinnitus and steadily progressive hearing loss.

In case of traumatic brain injury, a symptom of membrane destruction is auricular liquorrhea - leakage of cerebrospinal fluid from the ear canal.

Diagnosis of eardrum perforation

Otolaryngologists diagnose perforation of the eardrum using an external examination of the ear and otoscopy; detailed examination of the eardrum under a microscope (otomicroscopy).

To determine the degree of hearing loss, its acuity is measured - audiometry (tone and speech). The study can be carried out using a hardware method (audimeter) or using tuning forks and whispers of varying volumes according to special tables.

If there is a need to find out what condition the hearing analyzer is in, specialized clinics resort to digital impedance measurements (performed on computer audiological equipment). Impedance testing allows you to simultaneously study the mobility of the eardrum (tympanometry) and determine the level of sound conduction to the auditory ossicles located in the middle ear cavity.

It should be kept in mind that the perception of Hz tones at 25 decibels is an indicator of normal hearing. Hearing impairment is indicated by a person's inability to hear tones below 25 dB.

Treatment of eardrum perforation

Treatment of perforation of the eardrum has some peculiarities, since, according to otiatrists, most often the healing of a rupture or hole in the eardrum occurs by itself - through scarring. On average, this process lasts one and a half to two months.

And the main thing that therapeutic efforts are aimed at is to prevent the development of an inflammatory process in the middle ear, which can become infected after the impermeability of the eardrum is broken.

Patients with this problem need to protect the damaged ear from water, and doctors recommend that the hygiene of the ear canal be carried out very carefully: using a sterile cotton swab, slightly moistened with medical alcohol, and then closing the passage with a dry sterile swab.

But with the development of purulent otitis media, antibacterial drops must be used for perforation of the eardrum, which are used in the treatment of all purulent inflammatory diseases of the ears: Normax, Tsipromed, Otofa.

When the eardrum is perforated, Otof drops containing a powerful antibiotic rifamycin should be instilled into the ear: adults - 4-5 drops (in each ear), children - 3 drops; It should be instilled three times a day (for children - twice a day). Tsipromed ear drops based on ciprofloxacin are used for purulent otitis with perforation, 5 drops (three times a day), but they cannot be used before the age of 15 and during pregnancy. Normax drops contain the antibiotic norfloxacin and have the same contraindications as Tsipromed.

It should be emphasized that these drugs do not produce ototoxic effects, that is, they do not damage the innervation of the ear. But ear drops such as Polydexa, Sofradex, Garazon, Otinum, Otizol, Anauran, containing ototoxic antibiotics, are strictly prohibited for use in case of perforation of the eardrum.

If a small hole still does not heal, then it can be closed with a paper plaster, having previously treated the edges of the hole with a means that stimulates healing. And when the membrane rupture is large and does not heal itself for more than two months, an operation can be performed to treat the perforation of the eardrum - tympanoplasty (or myringoplasty), which restores the integrity of the membrane by grafting a skin flap.

In case of dry perforation of the eardrum, therapy is carried out by regular blowing of the ear - in order to restore pressure in the middle ear and improve hearing - in combination with physiotherapeutic procedures (pneumomassage of the eardrum, electrophoresis, UHF, quartz).

Prevention of eardrum perforation

The main direction of prevention is the immediate and correct treatment of inflammatory diseases of the ear, in particular otitis media. And for children - and all the runny noses. And you need to clean your ears correctly: do not use cotton swabs, but wash them with warm water and baby soap. The resulting wax plug can be driven even deeper into the ear on your own, so going to the clinic will be both easier and safer (where the plugs are washed out using the proven method).

Well, on the plane, don’t refuse the candy that the flight attendant offers: sucking candy, chewing, and swallowing movements help to avoid such unpleasant barotrauma as perforation of the eardrum.

Prognosis of eardrum perforation

The problem with tympanic membrane rupture, in general, is resolved with a positive prognosis for the future state of hearing. And only the possible consequences of perforation of the eardrum do not leave room for an optimistic assessment.

The most unfavorable consequences are the addition of an infection in the form of acute purulent inflammation of the middle ear, and in the case of inflammatory inflammation, the transition of inflammation to a chronic form or possible secondary infection.

Against the background of the chronicle, hearing deteriorates almost irreversibly. In addition, the following pathologies may develop:

  • labyrinthitis (inflammation of the inner ear);
  • mastoiditis (inflammation of the mastoid process);
  • thrombosis of the sigmoid venous sinus of the lining of the brain (with subsequent infection of the blood clot, complete blockage of the venous collector and inflammation of its wall);
  • cholesteatoma of the middle ear (cystic formation due to the proliferation of the epithelium of the ear canal through the opening due to marginal perforations of the eardrum);
  • facial paralysis;
  • intracranial infections.

Medical Expert Editor

Portnov Alexey Alexandrovich

Education: Kiev National Medical University. A.A. Bogomolets, specialty - "General Medicine"

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