1. Tympanic Membrane Perforation

2. Tympanic Membrane Perforation
Tympanic membrane perforation after removal of tympanostomy ventilation tube.

3. Definition A hole or tear in the eardrum(s)
Usually results from disease, trauma, or iatrogenic causes
Infection is the major cause of tympanic membrane perforation (TMP)
Perforation can be temporary or permanent (most perforations heal completely on their own)
Symptoms of perforation varies with size and location on the ear drum

4. Signs and Symptoms Ear pain that subside quickly Otorrhea Hearing loss
Tinnitus
Vertigo
Audible whistling sounds during sneezing and nose blowing
Frequent infection during colds or with water in the ear canal

5. Causes Middle ear infection (most common) Barotrauma Acoustic trauma
Physical trauma to the tympanic membrane
Severe head trauma 

6. Otoscopic Appearance

7. Tympanic Membrane Perforation
Otoscopy Appearance: Examination of right ear shows a clear canal leading to a perforated tympanic membrane. The drum is intact posteriorly up to the border of the malleus. Anterior (right of picture) to the malleus there is a large perforation extending from the superior to inferior borders of the annulus. The intact drum appears sclerotic. The middle ear is dry. R6

8. Diagnosis General Clinical diagnosis with otoscopy examination
Otomicroscopy can identify small perforation.
Middle ear impedance testing
Screening tympanometry may reveal abnormalities consistent
with perforation
Audiometry upon initial TMP diagnosis and before any
repair attempt
Imaging usually not indicated

9. Treatment Most traumatic TM perforations heal spontaneously
OK to watch and wait
Recommend dry ear precautions to prevent ear infection
Non-surgical in-office Treatments: eardrum paper patch
Surgery- Tympanoplasty (usually recommended after the age of 7)
2 reasons to do surgery:
Provide dry and safe ear
Restore hearing
This is a wrong statement …. You can suggest that patients can observe the ear drum with TM perf but you have to advise that there is a risk of recurrent infections and hearing loss. Even taking a shower an water getting into the ear can cause complications in patients with perforate TM
No treatment is necessary for non-swimming patients with minimal hearing loss and no history of recurrent ear infection
Hearing aid may prove the only necessary treatment for patients with symptomatic hearing loss but no infection or swimming history.

10. Complications
Hearing loss
Otitis media
Cholesteatoma