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Eardrum perforation – Tympanoplasty

Ear chronic problems usually begin from childhood. At this age, acute otitis is a very common phenomenon and in some cases when the microbe is quite toxic it may even cause perforation of the tympanic membrane (eardrum perforation). Perforation of the tympanic membrane can also be the result of a post-traumatic etiology.

The tympanic membrane serves to waterproof the deeper part of the ear and to protect it from the external environment. Rupture of the eardrum is likely to lead to contaminations difficult to treat, which gradually deteriorate hearing and they may cause vertigo episodes or other more serious complications.

Eardrum function is less important regarding sound transmission. In fact, simple perforation cases do not cause serious hearing loss. When serious hearing loss is detected we must suspect ear ossicles damage or damage of the deeper part of the ear called cochlea.

The patient visits the doctor with an episode of ear contamination of purulent otorrhea or after an ear trauma. In the case of contamination, treatment of the inflammation is of course the first thing to do. For this reason, local ear care by the doctor is more important than administration of antibiotics. This entails that the patient visits the doctor several times in order for the doctor to clean the ear and place antiseptic substances.

The ear during inflammation may present a rather perplexing image. To observe an eardrum perforation in an otherwise tranquil ear may be quite easy. However, during the inflammation phase, the tissue edema and the purulent secretions may lead to wrong estimations. Final diagnosis and a discussion about the way of treatment of the damage must follow once the inflammation is gone.

Hearing monitoring during the inflammation phase may be important, especially if the patient reports acute aggravation of hearing or loss of balance episodes. The above symptoms show that the cochlea, the deeper part of the ear is affected. In cases of post-traumatic eardrum ruptures, hearing measurement is necessary not only for estimating the range of the damage but also for monitoring ear improvement.

The first thing to do in post-traumatic ruptures is to avoid ear contamination. Many times, post-traumatic eardrum ruptures heal by themselves within a few months. Nevertheless, a contamination may turn an acute perforation into a permanent and larger one.

The ability of the tympanic membrane to heal by itself justifies the reason why we prefer to wait after a post-traumatic rupture, including in the case of an eventual damage of the ossicles. The only indication for an immediate intervention is the cochlea membrane rupture (the so called perilymphatic fistula).

Examination of the other ear is also important because in some cases it provides us with indications about the condition of the damaged ear before suffering an injury or inflammation. Thus, evidences of chronic malfunctions of the Eustachian in the “normal” ear shall make us not very promising regarding the expected result in the ear to be operated on. Besides, malfunction of the eustachian tube is the reason why we do not perform this intervention in children of less than ten years of age. Before the operation, a last audiogram is conducted in order to substantiate the hearing condition and to ascertain other possible damage apart from the ear perforation. Performing a CT is not considered except in some specific cases.

The operation we suggest to our patient is called tympanoplasty. In most cases it is performed under general anesthesia. Only when the rupture is very small, can we use local anesthesia. The patient remains in hospital for usually 24hours.

The incision for the intervention is done behind the ear. To cover the part of the ear drum that is gone, temporal fascia or a complex cartilage-perichondrium graft is used from the patient’s ear pinna. We propose the complex cartilage for large or anterior ruptures, as it is considered more resistant.

Once the procedure is over, the ear is filled with pieces of absorbable material and the patient’s head is bandaged. The patient leaves the hospital, with instructions not only for the immediate postoperative period but also for the subsequent ear care.