The eardrum, a delicate membrane located at the end of the ear canal, plays a critical role in sound processing. It collects incoming sounds, and when these sound waves hit the eardrum, they make it vibrate. This vibration is then passed on to the bones of the auditory system, called ossicles. In addition to its role in hearing, the eardrum acts as a protective barrier for the middle ear, keeping out debris and bacteria.
However, when there’s a hole or opening in the eardrum, known as an eardrum perforation, it can affect how smoothly these functions are carried out. The size of the hole can vary, from a small pinpoint opening to a complete loss of the entire eardrum. The team at Tejas Ear, Nose and Throat is here to help you understand your options regarding treatment and how you can take better care of your auditory health. What you need to understand is that the ear connects to the nose through a tube called the Eustachian Tube , A complete ear nose and throat evaluation is required .
What Causes a Perforated Eardrum?
When your eardrum is perforated, you may experience pain deep in the ear canal, a decrease in hearing and, at times, a discharge of fluids. Causes for a perforated eardrum include:
- Trauma: Direct impact, skull fractures or sudden explosions can cause eardrum perforation.
- Foreign objects: Inserting items too far into the ear canal, like bobby pins or Q-tips, may damage the eardrum.
- Infections: Untreated middle ear infections can lead to spontaneous rupture of the eardrum, causing perforation.
- Chronic Eustachian tube disorders: Long-term issues with the Eustachian tube can weaken the eardrum, contributing to perforation.
- Pressure-equalizing (PE) tubes: After their removal, small holes may persist in the eardrum.
- Chronic Eustachian tube problems: Persistent Eustachian tube issues may weaken the eardrum, leading to perforation over time.
While many perforations heal on their own, some may require surgery if they don’t heal naturally. The healing process typically takes weeks to months, during which the ear must be protected from water and trauma. The impact on hearing varies depending on the severity and cause of the perforation.
Does a Perforation Cause Hearing Loss?
Typically, the extent of hearing loss correlates with the size of the eardrum perforation – a larger hole often results in more significant hearing loss compared to a smaller one. Severe injuries, such as skull fractures that displace the bones in the middle ear, can lead to serious hearing loss, as well as the development of tinnitus (ringing in the ear). Chronic infections stemming from the perforation may contribute to prolonged or worsening hearing loss.
Eardrum Perforation Treatment
Before attempting to correct a perforation, a hearing test will commonly be performed to evaluate the extent of loss. Closing a perforation offers various benefits, including preventing water entry during activities like showering or swimming, which could lead to ear infections. It also improves hearing, reduces tinnitus and guards against the development of cholesteatoma, a skin cyst causing chronic infection and ear structure damage.
For small perforations, observation over time or in-office eardrum patching by an otolaryngologist are the most common recommendations. If you are experiencing more severe symptoms or are having difficulty with the healing period, the ENT doctor may recommend surgery.
Surgical Options
If a perforation persists for more than three months without signs of infection or drainage, the likelihood of spontaneous closure diminishes. In cases like this, your doctor might recommend considering surgical closure of the hole. The decision to pursue surgical closure involves various factors, including age, medical history, issues with the other ear and the extent of hearing loss.
There are two primary methods for repairing an eardrum perforation, both performed by an ear, nose and throat (ENT) surgeon. The simpler approach, known as patch myringoplasty, involves covering the perforation with a temporary material to encourage natural healing. This material, which can be paper, gelatin or a small piece of fat from the ear lobe, is chosen based on the size and location of the hole. Typically lasting five to 10 minutes, patch myringoplasty is suitable for relatively small perforations in the center of the eardrum.
On the other hand, the more common and extensive procedure, tympanoplasty, entails patching the eardrum hole with material that replaces the missing portion. During the surgery, the eardrum is lifted and a tympanic membrane graft is carefully inserted behind the eardrum. The eardrum is then repositioned, and the hole is patched from behind. The graft is supported by dissolvable packing material, which gradually dissipates over the next two-to-three months. During this period, the eardrum heals over the graft, returning to a normal appearance. Once the packing is fully dissolved, hearing is typically restored to normal levels.
While some tympanoplasties can be performed solely through the ear canal without requiring a large incision behind the ear, challenges may arise in cases with small ear canals or large perforations. In such instances, a larger incision, known as a postauricular incision, is made behind the ear to enhance the working space. Although a larger incision entails a longer healing and recovery process, it significantly improves the success of the operation in complex cases. When fully healed, the resulting scar is inconspicuous and concealed behind the outer ear. With success rates exceeding the high 90-percentile range, tympanoplasty is a highly effective intervention offered by Dr. Oscar Tamez at Tejas Ear, Nose and Throat.
Other procedures that may be recommended:
Balloon Eustachian Tube Dilation
Balloon Sinuplasty
Allergy Immunotherapy
What to Expect After Surgery
Recovery from myringoplasty and tympanoplasty involves a series of post-operative care measures. Following surgery, patients are advised to take it easy for a designated period, avoiding strenuous activities and refraining from blowing their nose. Sutures may be present, and it’s essential to keep the ear dry during the initial weeks, with instructions from the healthcare provider. Wound care commonly involves the use of hydrogen peroxide and anti-bacterial ointment for incision maintenance.
Pain control is typically managed with over-the-counter medications or prescription pain relievers as needed. Antibiotic ear drops may be prescribed for infection prevention. Children undergoing these procedures can often return to normal activities, including school, within a few days if they are eating well, sleeping comfortably and pain is effectively managed. Our team will be happy to guide you through the process from start to finish and is always available to answer your if you have any.