Tympanic membrane injuries (also: tympanic membrane perforation, tympanic membrane rupture) include ruptures (tears) and perforations (holes) in the membrana tympani. Injuries to the tympanic membrane are usually due to inflammation of the middle ear (otitis media) or direct or indirect force.
What are tympanic membrane injuries?
Sharp ear pain is the most typical characteristic of an eardrum injury. A tympanic membrane injury is a rupture or perforation in what is called the membrana tympani (eardrum), which is a thin membrane that protects the middle ear from external influences. Injuries to this membrane are manifested by stabbing pain in the ear (especially in the case of tympanic membrane ruptures), impaired hearing, slight bleeding in the ear in the case of a tympanic membrane rupture, and possibly purulent otorrhea (ear flow) in the case of tympanic membrane perforations. Pathogens or foreign bodies that have penetrated the damaged areas of the eardrum can also cause otitis media (inflammation of the middle ear) and lead to inflammatory reactions. Dizziness, nausea, vomiting as well as throbbing ear noises (tinnitus) and nystagmus (eye tremor) can be the result. Furthermore, in some cases, a tympanic membrane injury with an irritated inner ear can cause paralysis of the facial nerve.
Causes
Injuries to the tympanic membrane are usually due to barotrauma (detonations, blows to the ear with the flat of the hand, disturbed pressure equalization during flying or diving), direct damage to the membrane by sharp or blunt objects (cotton swabs, hairpins), infection (otitis media), or iatrogenic causes (improperly performed ear irrigation). In addition, a major force on the ear can cause damage to the middle ear (injury to the ossicle) and possibly to the inner ear. In addition, burns (sweat bead injury) and chemical burns can damage the tympanic membranes. Longitudinal petrous fracture (form of skull base fracture) is also associated with tympanic membrane rupture in many cases. If an injury to the tympanic membrane was already present, the risk for recurrence of rupture or perforation is increased.
Symptoms, complaints, and signs
A tympanic membrane injury usually affects only one ear. That both hearing organs are affected to the same extent is an exception. In addition to acute symptoms, secondary damage can occur if treatment is delayed or omitted. The most common symptom is pain in the ear. This occurs during or shortly after the injury. However, it disappears after a few seconds. In rare cases, it is accompanied by a small discharge of blood from the ear. Acute disease usually causes small tears in the eardrum. Affected persons do not perceive any noticeable hearing loss afterwards. If, on the other hand, damage occurs to the auditory ossicles, permanent reductions in hearing are possible. In addition to the direct symptoms in the ear, the body sometimes reacts with further complaints. Those affected then complain of dizziness. Nausea is also sometimes experienced. The eyes move rapidly back and forth. In the case of extensive injuries, doctors regularly diagnose a middle ear infection. Facial paralysis may also set in. An eardrum injury can lead to permanent damage to hearing. For example, patients can no longer understand conversations clearly in a noisy environment. Constant ringing in the ears accompanies everyday life. This reduction in hearing ability can develop into deafness in the worst case.
Diagnosis and progression
In many cases, a suspicion of injury to the tympanic membrane already results from the medical history as well as the description of the course of the accident and the specifically present symptoms. The diagnosis is confirmed in the course of an otoscopy (ear examination) and/or ear-miscroscopic examination. A hearing examination allows statements to be made about the presence of conductive hearing loss (hearing loss), impairment of the inner and middle ear, and damage to the ossicles. If the injury is due to force from objects or liquid metal, an x-ray examination may be indicated to locate residual foreign bodies or foreign body fragments. Generally, tympanic membrane ruptures and perforations have a good prognosis and heal without complications.In cases of marked injury to the tympanic membrane involving the inner and/or middle ear, irreversible hearing loss or deafness may result.
Complications
Direct tympanic membrane injuries may result in damage to the ossicle. It is responsible for transmitting sound from the eardrum to the inner ear. Dislocation of the ossicle is also not uncommon. This is a joint injury that often results in a joint capsule tear. Hearing is severely limited as a result, often resulting in deafness. Middle ear infections are among the most common complications: If acute, it is particularly painful as it progresses, leading to pulsing, throbbing and ringing in the ears that further clouds hearing. Fever, nausea and vomiting occur in a more severe course of inflammation. Furthermore, there is a risk of perforation of the medial wall of the tympanic cavity, the cavity in the middle ear located directly behind the eardrum. It is responsible for equalizing pressure in the ear. It is not uncommon for meningitis to occur when the tympanic cavity has been affected. In this case, bacteria, viruses, and fungi nest in the injured tissue and convulsions, photophobia, and apathy may result. Labyrinthitis is also often the result. The labyrinth of the inner ear becomes inflamed and the entire ductal system is negatively affected. In the worst case, pus forms, leading to deafness if severe.
When should you go to the doctor?
In the event of an injury to the eardrum, a doctor should be consulted in any case. If pain occurs in the area of the ear canal or hearing suddenly worsens, medical advice is needed. If blood is leaking from the ear canal, it is best to see an ear specialist immediately. An injury to the eardrum must be clarified and treated to avoid restrictions in everyday life and to rule out complications such as an infection of the middle ear. Increasing ear pain or purulent secretion in the area of the ear indicate an injury that must be investigated. If the complaints occur after attending a concert, the eardrum may have ruptured. The ear specialist can diagnose the condition with the aid of an otoscope and arrange for further measures. This should be done as early as possible to avoid further deterioration of hearing. If the eardrum is damaged by an accident, the emergency services must be called. Before this happens, the ears can be cleaned carefully. People who expose their ears and ear canals to great stress should visit the specialist at regular intervals.
Treatment and therapy
Therapeutic measures for injuries to the eardrum depend on the severity of the damage. For example, minor injuries usually heal on their own within a few days without requiring treatment. During the convalescence phase, however, the affected ear should be kept dry, for example by protecting it with an ear bandage or cream absorbent cotton during showering or bathing. If a perforated eardrum is diagnosed as a result of otitis media, decongestant nasal and/or ear drops and antibiotics are also used. If a ruptured eardrum is characterized by rolled-in or rolled-up edges of the injury, these are tightened and the affected eardrum is splinted with a silicone sheet to ensure that the edges grow together smoothly. If the injury has not healed after a few weeks (4 to 6), surgical closure is required to restore sound conduction. For this purpose, the natural shape of the tympanic membrane is reconstructed in a myringoplasty by substituting adjacent tissue (fascia, cartilage, perichondrium) for the missing parts of the ruptured or perforated tympanic membrane. If necessary, smaller defective areas can be replaced by the patient’s own fatty tissue. As a rule, injuries to the middle and/or inner ear (damage to the ossicles) can be repaired at the same time during this procedure (tympanoplasty). Following the reconstruction, the eardrum is stabilized using a silicone sheet.
Prevention
An eardrum injury cannot be prevented in every case. However, barotrauma resulting from detonations can be prevented by appropriate hearing protection.Injury to the eardrum can also be avoided by refraining from cleaning the ear canal with cotton swabs or other pointed objects. If a cold or otitis media is present before a flight or dive, it should be avoided. The so-called Valsalva maneuver (forced exhalation with the nasal and mouth openings closed) minimizes the risk of eardrum injury during the takeoff and landing phases of airplane travel.
Aftercare
Tympanic membrane injuries can regenerate well with consistent aftercare. Competent contacts in this context are the ENT physician or also the hearing aid acoustician. A check-up with the doctor provides certainty that the injury is healing optimally. The doctor determines the frequency and rotation of the control checks. The patient is also responsible for the success of the follow-up with his or her cooperation. For example, it is important to avoid pressure on the eardrum at all costs during the healing phase to prevent a new rupture. Diving is a sport to be avoided due to the pressure on the eardrum during the aftercare phase. Air travel can also overstress the eardrum and should be undertaken in consultation with the physician. To prevent particles from entering and contaminating the ear canal when the eardrum is leaking, protective measures are also advisable during the aftercare period. For example, when washing hair or taking a shower, water with shampoo residue should not get into the ear. Anyone who has poor hearing or tinnitus as a symptom due to the eardrum injury should be patient and not overexert themselves either professionally or privately during the aftercare period. Those who prefer to read a book in peace and refrain from listening to music can often support the regeneration of eardrum injuries in the long term. Anyone who suspects hearing damage can clarify this in an uncomplicated way with a hearing test at a hearing care professional.
What you can do yourself
Mild conditions usually do not require further treatment. Small tears close up again on their own. Affected people benefit from the self-healing power of the eardrum. However, they can support recovery by taking it easy and avoiding loud environmental noises. It is also essential to keep the ear dry. When showering, it is advisable to use moisture-repellent absorbent cotton. Shampoos must not get into the ear canal. They can reopen wounds due to the substances they contain. Self-help measures are generally not advisable if complications such as blood flow, pain or hearing loss develop. Patients can use over-the-counter nasal drops to speed recovery. This improves ventilation of the ear canal. A pharmacist will advise on appropriate preparations. In addition, exercise should be avoided after an acute illness. Patients should not lie on the diseased ear at night. In winter, a cap or headband should be worn when walking in the fresh air. Eardrum injuries particularly affect workers in noisy environments. They should be sure to use hearing protection. This preventive measure is the best way to prevent disease. Employers are required to provide protective equipment.
