1. TM Perforations
Beth Burlage

2. Definition
Perforation - a hole or pattern made by or as if by piercing, in this case, in the tissue of the tympanic membrane

3. Anatomy
Normal Tympanic Membrane

4. Types Central Perforation Marginal Perforation
Most common, perforation in which a portion of the TM surrounds the hole
Marginal Perforation
Perforation involves the edge of the TM

5. Causes Traumatic Perforations
Penetrating Injury - these are direct injuries which may occur when cleaning the ear with a foreign object
Implosion - inward burst of the ear drum caused by a strike such as a slap or punch to the ear

6. Causes Resulting from Infection
Bacteria and viruses can weaken and deteriorate the TM

7. Causes
Chronic
Long-standing perforations are possible in those who have eustachian tube problems and infections

8. Examples

9. Diagnosis History Otoscopy : Perf vs. retraction pocket
Pneumatic Otoscopy
Tympanometry : Large volume
Weber/Rinne Tests
Audiogram: Conductive/Mixed loss

10. Treatment Spontaneous healing Avoid water Observation
Surgery may be required
The cause of the perforation will determine the ultimate course of treatment. Accompanying conditions should be treated medically.

11. Consequences Otorrhea Hearing loss Scarring
The hearing loss will be a conductive loss; recurrence may cause scarring which can lead to a permanent conductive loss due to immobility

12. Prevention Don’t stick anything smaller than your elbow in your ear
Medical treatment for infection

13. Accompanying/Rare Conditions
A large conductive loss may point to ossicular damage
Perforations in the posterior and superior position can lead to a cholesteatoma
Multiple perforations may indicate tuberculosis, often in the presence of AIDS

14. Clincal Examples
Experiences?

15. References
Menner, A. (2003) A pocket guide to the ear. New York: Thieme.
Madigan Army Medical Center (2006) Tympanic Membrane Performation. Retrieved on April 12, 2008