Disease Description (Causes and Symptoms)
- Definition: A condition in which trauma causes a tear or hole in the eardrum (tympanic membrane), interfering with the transmission of sound waves and mainly resulting in conductive (middle-ear) hearing loss.
- Causes: External impact (blows to the head or around the ear), perforation caused by foreign objects such as cotton swabs, explosive sounds or sudden changes in air pressure (barotrauma), and accidents such as traffic accidents or falls.
- Pathophysiology: When the continuity of the eardrum is disrupted, transmission of eardrum vibrations decreases, causing hearing loss. If bacteria enter the middle ear, infectious discharge may occur. In severe trauma, ossicular damage or an inner-ear leak (perilymph fistula) in addition to eardrum damage may cause vertigo and severe hearing loss.
- Main symptoms: Hearing loss, tinnitus, ear pain (usually temporary), bleeding or pus (discharge) from the ear, and, in severe cases, dizziness (when the inner ear is injured).
Treatment Methods
- Initial phase (minor perforation, no infection)
- Most heal spontaneously (over several weeks to a few months) → observation
- Protect the ear from water and contaminants (earplugs are recommended), and take care not to allow water to enter the ear canal
- If there is pain, use pain relievers (e.g., ibuprofen, acetaminophen)
- When infection or discharge (otorrhea) is present
- Use topical antibiotic ear drops for the ear surface (ear canal) as directed by a doctor
- Systemic antibiotics are considered when there are signs of systemic or severe infection, such as middle-ear infection
- Interventional treatment
- Promote epithelial growth at the edges using a paper patch or adhesive patch (attempted for small perforations)
- If healing does not occur after observation for 2–3 months or longer, or if the perforation is large and there are recurrent infections, surgery (tympanoplasty or myringoplasty)
- If ossicular damage or an inner-ear leak is suspected due to severe trauma, imaging (CT) and specialist surgical evaluation are necessary
- Lifestyle management and precautions
- Do not insert cotton swabs or other objects into the ear
- Protect the ear when showering or swimming so that water does not enter the ear (waterproof cap)
- Avoid activities involving major pressure changes, such as flying or scuba diving, until healing is complete (consult a doctor)
- Prognosis
- Most small traumatic perforations heal spontaneously
- With surgery, an eardrum repair and hearing improvement can be expected, with a success rate of over 90% (varies depending on the source)
Checklist Before an Outpatient Visit (Including Example Questions)
- Items/information to prepare
- The time symptoms began (exact date/time) and how the condition developed (what trauma or situation occurred)
- A record of symptom changes (changes in hearing, color and amount of discharge, pain, and whether dizziness is present)
- Medications currently being taken (especially anticoagulants, antithrombotic agents, etc.)
- History of previous ear disease (otitis media, previous surgery, or recurrent eardrum perforation)
- Bring any previous hearing test results or imaging results (CT/MRI), if available
- Record in advance the items the doctor may ask about during the outpatient visit
- Whether there was loss of consciousness at the time of trauma, and whether there was a nosebleed or head injury
- Whether water or a foreign object entered the ear
- Whether fever or systemic symptoms are present
- Situations in which an emergency visit is recommended (seek immediate medical care)
- Severe bleeding, sudden severe dizziness or nausea/vomiting, facial nerve paralysis, or high fever
Examples of General Questions to Ask a Doctor
- How likely is it that this eardrum perforation will heal on its own? What is the expected healing period?
- Is surgery (tympanoplasty) necessary in my current condition? If so, when would you recommend it?
- What are the side effects of the prescribed medications (topical and oral)?
- What activities should I avoid in daily life while it is healing (showering, swimming, flying, etc.)?
- How much hearing recovery can be expected? When should I have a hearing test?
Examples of Condition-Specific Questions
- What are the size and location of my eardrum perforation? (e.g., central, anterior, posterior, etc.) — The prognosis and surgical method may vary depending on the location
- When discharge comes from my ear, which ear drops (topical antibiotics) should I use, and for how long?
- I had inner-ear symptoms (dizziness) at the time of the trauma. How will the possibility of inner-ear damage (e.g., perilymph fistula) be evaluated? When should I have additional tests (CT, hearing test, vestibular function test)?