You have a hole in your ear. So says the doctor who checked it. How’d you get? Did you:
1. Have
a cold, then a plugged ear, then excruciating ear pain followed by bloody-yellow
drainage and relief of the ear pain? or
2. Take an airflight, and upon descending the
darn pilot forgot to properly depressurize the cabin? or
3. You
went water-skiing, fell and slammed your ear hard onto the water? or
4.
Somebody slapped the side of your head, right over your ear, for some
stupid thing you said or did? or
5.
You took it upon yourself to clean your ear with a Q-tip (a brand
of cotton swab bearing a package label that says, “DO NOT INSERT INTO EAR…COULD
CAUSE INJURY), but used your better judgment to ignore this warning, went a
little too far, and experienced sudden ear pain and hearing loss?
Yeah, you probably ruptured your eardrum. Any of these situations can create a nice
hole, called a tympanic membrane perforation, shortened to TM perf
in medical-speak. Welcome to the world
of holey (or holy?) eardrums.
For case no. 1, and ear infections such as
otitis media, fluid and pus
fills the middle ear and bulges the TM outward until it ruptures through a weak
spot in the TM. This happens mostly in
young children, but can occur in adults.
Often the ear pain improves since the middle ear is decompressed once
all that wonderful pus is released.
Case 2 is the reverse of the first, where
the eustachian tube closes upon descent (see eustachian tube (ET) dysfunction) where
atmospheric pressure is greater than middle ear pressure such that the TM is
sucked inwards. This causes a retracted
eardrum. If this occurs quickly, it can
rupture the TM. Also if the suffering
person tries to clear the ear too forcefully (Toynbee maneuver or blowing the
nose too hard), this could shunt air pressure up the ET, into the middle ear
and out through the TM.
Cases 3 and 4 represent the same mechanism
of action, where direct pressure to the ear from the outside ruptures the TM,
in what is known as otic barotrauma.
Case 5 should be a no brainer: any foreign device placed into the ear can damage it. Even Q-tips or cotton-tipped applicators, and I’ve see a few TM perforations from that very source, which is the reason we always tell patients to never-never-never use these things in their ears! (see Ear Cleaning Do’s and Don’ts and also, Ear Cleaning: If You Must, to really drive this message home). And while you’re at it, never use Ear Candles. They don’t work. Period. The risks far outweigh any benefit, which is none. Enough said.
Treatment
After the cause of the TM perforation is
treated (ie, oral antibiotics or antibiotic ear drops for the infections), it’s
usually a wait-and-see approach for the TM to heal on its own. Acute perforations typically do not require
immediate repair. We often allow 3-6
months to pass, since most TM perfs eventually heal and close, where the
membrane regenerates from the edges of the perf. The photo below demonstrates this well: it’s
the same ear shown at the beginning of this post, only 4-5 months later a neo-membrane
(“new membrane”) has grown and closed the perf.
I’ve seen near-total perforations from trauma heal completely, with
hearing restored back to normal. Surgery
is considered if the TM does not heal after this time, or if there is concern
for damage or disruption to the bones of hearing (ossicles).
As long as the patient keeps the ear dry, avoids activities that can disrupt formation of the neo-membrane (i.e., hard nose blowing, flushing the ear, or unwisely using a Q-tip again), the majority heal spontaneously. This is an example of patience being a virtue.
©Randall
S. Fong, M.D.
For more topics on
medicine, health and the weirdness of life in general, check out the rest of
the blog site at randallfong.blogspot.com
Comments
Post a Comment