Perforated Tympanic Membrane
A perforated tympanic membrane (eardrum) refers to a defect or tear in the tympanic membrane that creates an abnormal communication between the external auditory canal and the middle ear.
This updated UKMLA guide to perforated tympanic membrane is based on ENT UK guidance, which covers causes, symptoms, diagnosis and management.
Causes
Most common: infection (esp. acute otitis media, less commonly otitis externa) [Ref]
Other causes: [Ref]
- Traumatic (mechanical forces)
- Blunt blows to the ear (e.g. boxing)
- Falls onto water surfaces (e.g. waterskiing, surfing)
- Barotrauma (e.g. explosions, atmospheric pressure changes)
- Excessive water pressure in scuba diving or snorkelling
- Iatrogenic (otologic procedures like myringotomy, tympanoplasty, cochlear implantation)
Clinical Features
The presentation highly depends on the underlying cause [Ref]
- Perforation from acute otitis media presents as
- Sudden relief of otalgia (as the perforation relieves the pressure)
- Ear discharge (otorrhoea)
- Hearing loss in the affected ear
- Traumatic or iatrogenic cases classically present with sudden unilateral hearing loss +/- tinnitus immediately following the causative event
Investigation and Diagnosis
First, perform an otoscopic examination of the ear to visualise the external auditory canal and tympanic membrane directly
- Look for any defects or a hole in the tympanic membrane
- Look for signs of infection
Hearing assessment:
| Assessment | Findings in tympanic membrane perforation |
|---|---|
| Rinne and Weber tests | Tympanic membrane perforation causes conductive hearing loss in the affected ear
See the Hearing Loss article for more information |
| Pure-tone audiometry | Tympanic membrane perforation causes conductive hearing loss with an air-bone gap |
Management
Key management principles:
- Most tympanic membrane perforations heal spontaneously
- Advice on water exclusion
- Avoid instrumentation of the ear
- Refer to ENT if the perforation fails to heal after 3 months
ENT may consider performing surgical repair (e.g. tympanoplasty +/- graft placement)