Disease Description (Causes and Symptoms)
- Definition: Traumatic tympanic membrane perforation is a condition in which a hole or tear develops in the tympanic membrane due to external impact or a penetrating injury, affecting sound transmission.
- Causes: Direct impact to the ear (such as a fist), insertion of foreign objects such as cotton swabs or hairpins, explosions (sudden pressure changes), and head injuries caused by traffic accidents or falls.
- Pathophysiology: When the continuity of the tympanic membrane is disrupted, air conduction is reduced, resulting in conductive hearing loss. If bacteria enter through the damaged area of the tympanic membrane, infections of the external auditory canal and middle ear (secondary infection) may occur. Severe trauma may also damage structures within the middle ear (ossicles, the entrance to the cochlea, etc.) or vestibular function.
- Main symptoms: Sudden ear pain (usually temporary), bleeding or bloody discharge (otorrhagia), pus (in cases of infection), decreased hearing (usually conductive), tinnitus, and dizziness or nausea (in cases of inner ear damage).
Treatment Methods
- Initial management (mild perforation, with no evidence of bleeding or infection)
- Observation for spontaneous healing: Small, central perforations may close spontaneously within several weeks to several months.
- Pain management: Analgesics such as NSAIDs.
- Prevent water from entering the ear: Use earplugs when showering or swimming.
- Nasal care: Avoid forceful nose blowing (blowing the nose forcefully) to prevent air from flowing backward into the middle ear.
- When infection is suspected or discharge (pus) is present
- Topical antibiotic ear drops: In the presence of a perforation, avoid ear drops containing potentially ototoxic ingredients (including neomycin); fluoroquinolone-based ear drops (e.g., ofloxacin) can be used safely.
- Systemic antibiotics: When there are signs of severe otitis media spread (lymph node swelling or systemic symptoms) or when needed before or after surgery.
- Temporary treatment (outpatient)
- If there is little draining discharge and the edges of the perforation are damaged, an absorbable patch (for hemostasis and promoting mucosal regeneration) may be applied (such as an outpatient micropatch or paper patch).
- Surgical treatment
- For a persistent hole (usually when it has not closed spontaneously for 3 months or more), or in cases of a large perforation, recurrent infection, or suspected ossicular damage: Tympanoplasty (tympanoplasty, myringoplasty) is performed.
- For temporal bone fractures, ossicular damage, or inner ear damage accompanying the trauma, additional surgery or reconstruction may be considered.
- Imaging and tests
- The location and size are confirmed by otoscopy, and the degree of hearing loss is evaluated by pure-tone audiometry (audiometry).
- Temporal bone CT is recommended in cases of severe head trauma or suspected complex injury.
- Prognosis and precautions
- Small traumatic perforations usually heal spontaneously. The likelihood of requiring surgery increases when the perforation is large or accompanied by infection.
- The surgical success rate is relatively high (80–95% in the literature).
- Follow the doctor's prescription when using antibiotics or ear drops. Do not insert foreign objects into the ear, and take precautions with swimming, diving, and flying (sudden pressure changes).
Outpatient Visit Checklist (Including Preparation Items and Example Questions)
- Preparation items
- A list of all medications currently being taken (including prescription medications, OTC medications, and supplements)
- A record of when and how the symptoms began (when they occurred and following what type of trauma)
- Notes or photographs showing changes in symptoms (hearing changes, the color and amount of discharge, whether dizziness is present, and the degree of pain) (when discharge comes out of the ear)
- Previous hearing test results or related images (if available)
- History of previous ear surgery or chronic otitis media
- Items that are useful to record so that you can answer them yourself during the outpatient visit
- Has fluid (clear, bloody, or pus) ever come out of the ear?
- Are dizziness or a sudden severe decrease in hearing present?
- Is there a history of nasal congestion, nasal septum problems, or nasal infection?
- History of recent antibiotic use
Examples of General Questions to Ask the Doctor
- "How likely is it that my eardrum perforation will heal on its own? How many weeks should I wait?"
- "What are the side effects and instructions for using the ear drops currently available to me?"
- "If surgery is needed, when do you recommend it? What are the risks of the surgery and the expected results?"
- "What activities should I avoid in daily life? (Swimming, showering, flying, etc.)"
Examples of Disease-Specific Questions
- "What are the size and location of the perforation, and how much hearing loss would be expected based on them?"
- "What additional tests are needed to check for complications such as dizziness or facial paralysis (e.g., CT, hearing test, vestibular function test)?"