Perforated Tympanic Membrane

Question 1

What is the most common cause of perforated tympanic membrane?

Answer 1

Most common cause = infection i.e. acute otitis media with perforation

Other causes:

=> Trauma (barotrauma / physical)

=> Previous surgery e.g. grommets

Question 2

How does perforated tympanic membrane present?

Answer 2

Ear pain when perforation occurs

Blood may discharge at time of perforation

Hearing loss

Recurrent discharge

*Increased risk of otitis media

Question 3

How is perforated tympanic membrane managed?

Answer 3

1. Most cases managed conservatively because perforation often heals within 6-8 weeks if traumatic in origin or secondary to otitis media with perforation

=> advice patient to keep ear free of water (e.g. use cotton wool smeared with vaseline in the bath/shower, swimming cap/ear plugs etc)

2. Infected perforations following acute otitis media may require antibiotic ear drops
3. Reconstruction of eardrum (myringoplasty/tympanoplaty) if tympanic membrane doesn’t heal by itself i.e. in recurrent ear infections