eardrum

Eardrum perforation: description

The eardrum is a continuous membrane and separates the ear canal from the middle ear. It is the barrier between the outer ear (auricle and ear canal) and the invisible part of the ear where the sound is processed. Sound waves cause the eardrum to vibrate, which it transmits to the ossicles in the middle ear. This amplifies the sound waves and forwards them to the inner ear, where they are converted into nerve impulses. The brain finally processes these signals and we perceive them as sounds and sounds.

If the eardrum burst or cracked (ie perforated), this affects the conversion and transmission of the sound waves. Affected listen to the corresponding ear in the episode worse. A drum injury usually arises only on one side, but – depending on the cause – can also occur on both sides.

Tympanic membrane perforation: symptoms

A tear in the eardrum is not necessarily bad. A middle ear infection often heals faster, for example, once the eardrum has burst. Symptoms include pus flowing from the ear and hearing loss, while pain is scarcely or not at all. In fact, the pain that was previously caused by the increased pressure in the middle ear is actually diminishing. The resulting hole in the eardrum is usually small and causes only a slight hearing loss, because the eardrum can still act sufficiently as a sound amplifier.

If a knock on the ear, or other violence is the cause of a tympanic membrane rupture, the hearing loss is often stronger. Even pain is often the result. Depending on the size of the injury, even blood can escape from the ear. At high pressure waves, sometimes not only the eardrum bursts, but also the auditory ossicles are torn from their anchorage (luxation).

With such great damage to the eardrum and ossicles, the damage does not heal by itself and you have to expect a lifelong, severe reduction in hearing. An operation is then the only way not to lose the sense of hearing forever.

Eardrum perforation: complications

The eardrum provides a natural barrier to pathogens. If a tympanic membrane perforation, pathogens can easily enter the middle ear and thus trigger infections or hinder the healing of existing inflammation.

Tympanic Perforation: Causes and Risk Factors

The eardrum perforation usually happens in the context of an inflammation or a forceful impact on the ear. In addition, there are some risk factors that favor a hole in the eardrum.

Tympanic membrane perforation in middle ear infection

An eardrum perforation often occurs as part of a middle ear infection. Due to the inflammatory process, the eardrum loses stability, and because of the pressure increase in the middle ear, it is under tension and less well supplied with blood. Middle ear infections can be acute or chronic.

In acute middle ear inflammation, pus in the middle ear forms within a few days. Normally, pus and secretions can drain into the pharynx via the Eustachian tube (tuba auditiva). However, if this connection is misplaced, perhaps due to swelling of the mucous membranes, the pressure in the middle ear increases steadily and in some cases causes perforation of the eardrum. The pus can then drain away through the hole in the eardrum.

Usually it does not come that far. Acute otitis media usually resolve after just a few days, without the need for medication, or pus escaping from the ear.

Acute otitis media can also become chronic in rare cases. The process of inflammation then lasts several weeks or even longer and almost always causes a hole in the eardrum.

If the effusion in the middle ear is not sufficiently drained, it is possible to insert an artificial eardrum hole (tympanic tube) into the eardrum. Through the improved ventilation, the inflammation heals faster and further complications are prevented. After a few months, the eardrum closes itself and the small plastic tube falls out. Eardrum perforation can also protect the ear from more severe inflammation or destruction of the ossicles.

Tympanic membrane perforation through trauma:

In severe accidents, or falls with skull base fracture, it may, depending on the fracture line, come in addition to a tympanic membrane perforation. Even explosion or very loud or strong sound and pressure waves often cause a tympanic membrane tear (explosion trauma). Delineation is the explosion trauma of a bang trauma, which also leads to an acute hearing loss, but the eardrum is not damaged.

Some people try to clean the ear canal with cotton balls. Since manipulation in the ear is a risk of eardrum perforation, doctors generally advise against cleaning the ear canal with cotton swabs. In addition, the earwax is often advanced only deeper into the ear canal or by small injuries inflammation of the ear canal are favored.

Eardrum perforation: examinations and diagnosis

The ENT doctor examines the eardrum with the help of an otoscope, a small lamp with a plastic attachment, which is inserted into the ear canal. If the eardrum is ruptured or irritated by inflammation, this can usually be detected. In addition, the doctor can change the pressure conditions in the ear canal with the help of a small balloon and thus observe the eardrum as it moves. This is important, for example, in chronic inflammation or as a control in healing a tympanic membrane perforation.

Even if the examination is perceived by many people as uncomfortable, the direct look into the ear with the help of the otoscope is the easiest and quickest way to determine a hole in the ear or a middle ear infection.

A hearing test can also provide evidence of damage to the eardrum or ossicles. In addition to a computer test, there are more old-fashioned test procedures in which a tuning fork is placed on the head or held directly in front of the auricle.

Eardrum perforation: treatment

The treatment depends on the cause and location of the hole in the eardrum. Surgeries are only necessary for lengthy or major injuries. Often, the tympanic rupture heals by itself.

The eardrum has a high self-healing tendency. Even with multiple eardrum tears, the eardrum often heals without medical help. Especially when the hole in the eardrum is not on the edge, but in the middle of the eardrum, the eardrum perforation usually heals without consequences.

If the eardrum is torn because of an accident or fall, or if the eardrum edge is injured, the eardrum usually does not heal so well. In the case of edge injuries, the skin from the auditory canal can also grow into the middle ear and thus disturb the ossicles. This leads to further infections and prevents inflammation from healing. There is a risk that the inflammation will spread to the organ of balance or even the meninges. In such a case, surgery is essential.

In such an operation, the eardrum is splinted with paper or silicone and any adhesions removed. With cartilage or muscle, an endogenous, artificial eardrum can also be used. All these interventions work through the very small ear canal. Such interventions are technically complex and require a lot of practice and tact.

In children who are often suffering from acute middle ear infections, it is attempted to aerate the middle ear with the help of decongestant nose drops. This often prevents eardrum perforation. Severe middle ear infections are treated with antibiotics. However, antibiotics are not necessary for every otitis media.

Since a burst eardrum is a port of entry for germs in the ear, should be avoided with a hole in the ear water sports.

Tympanic membrane perforation: disease course and prognosis

The course of the disease and the prognosis of eardrum perforations are usually good. Because of the high self-healing tendency, not even medical intervention is necessary. Hearing usually does not sustain lasting damage.

In case of accidents or impact injuries with eardrum The course often looks different. Depending on how bad the eardrum is injured, the ENT doctor must operate the eardrum. In particular, if the ossicles are damaged, a long-term hearing loss on the affected ear is possible and often unavoidable.