The eardrum is a thin tissue inside the ear canal that separates the outer ear canal from the middle ear. One of the most important causes of perforation of the eardrum is infection. Infections in the ears, especially in children, are likely to puncture the eardrum. If the ear becomes infected, inflammation and similar fluids accumulate in the ear and this puts pressure on the eardrum. If this amount of pressure increases then the ear can be pierced. Another condition that causes ear piercing is pressure. The body pressure on the back of the eardrum should be equal to the ear pressure on the front. Sudden changes in this pressure equation can cause the eardrum to perforate. These sudden pressure changes; It can occur during airplane trips, water diving sports and sudden altitude changes on land trips. Injuries and blows are also important conditions that can cause perforation of the eardrum. Excessive physical exertion to the ear can damage the eardrum. Impacts and blows, skull bone fractures, excessive insertion of objects such as cotton swabs into the external ear canal, liquids that will be harmful to the ear, and being in very noisy environments can cause the eardrum to perforate. Apart from these, the perforation of the eardrum in some people may also be congenital.
The symptoms of perforation of the eardrum are as follows;
– Complete and partial hearing loss
– Feeling of ringing and buzzing in the ear
– Pain in the ear
– Fluid discharge from the ear mixed with water, inflammation and blood
– Dizziness in cases where ear piercing is important
People may not care about the situation when these symptoms are not very disturbing, but in cases where they are not taken into account, infection-related hearing loss may occur, so everyone who experiences these symptoms should definitely consult a specialist ENT doctor.
Treatment of Eardrum Perforation
Most perforations in the eardrum heal on their own within a few weeks. However, in some punctures, the eardrum cannot repair itself and the puncture may be permanent. If the eardrum does not repair itself in at least 6 weeks, then a surgical intervention may be required.
If there is excess discharge in the ear, your doctor will first clean this ear canal. The inside of the ear is looked at with a lighted instrument called an otoscope. If there is a hole or tear in the ear, it can be seen during this examination. An audiometry test may also be requested to measure hearing. In this test, the patient listens to sounds at different frequencies with the help of headphones and presses the button in his hand every time he hears the sounds. Treatments are primarily applied to reduce the pain in the ear and to eliminate the risk of inflammation. For this, first of all, drug treatment is applied, and at the same time, it is recommended to apply a warm and dry cloth to the ear several times a day. Antibiotics may be needed to treat or prevent an ear infection. antibiotics; In addition to healing the infections in the ear that cause the perforation of the eardrum, it also prevents the infections that are at risk of injury as a result of the perforation of the eardrum. If the puncture causes pain, it is considered appropriate to also use painkillers. However, surgical intervention is needed in the eardrum holes that do not close after these treatments.
Eardrum Perforation Surgery
In order to heal the perforation of the eardrum with surgical interventions, the membrane is covered with a tissue and the puncture is closed and the progression of the patient’s hearing loss is prevented. Two techniques, “Tympanoplasty” and “Myringoplasty”, are applied in surgical interventions in eardrum perforation. The size of the eardrum tear, the location of the tear, the structure of the ear canal, the condition of the patient and whether or not to intervene in the mastoid bone during the surgical procedure affect the surgery.
In surgeries performed with the tympanoplasty technique, the eardrum and the auditory system in the middle ear are repaired. Tympanoplasty is performed with incisions made from the inside of the ear canal, behind the ear or from the anterior part of the auricle. In order to repair the rupture of the eardrum, an incision is made through the ear canal or from the front of the auricle. If the mastoid bone is also to be treated, the operation is performed by making an incision from the back of the ear. Inflammation in the bone is also cleared. The tissue used to repair a ruptured or perforated eardrum is usually obtained from the sheath of the temporal muscle. Ready-made materials similar to cartilage or eardrum pieces, which have undergone the necessary procedures for tissue repair, are used. Usually, the patient’s own tissues are used during the procedure. The operation is finalized according to the patient’s condition and the operation is shaped accordingly. It can be done only by repairing the hole in the eardrum, clearing the inflammation that has progressed into the mastoid bone, repairing the ossicular system that provides sound transmission in the middle ear with membrane repair, or including all of these conditions.
Another technique is myringoplasty surgery. This operation is applied when the eardrum does not repair itself within 6 weeks and there is no positive response to the treatments. Myringoplasty is a patch procedure. It is a surgical intervention performed by closing small tears or holes in the eardrum with tissue. It is very important for this surgery that there is no problem in the ear ossicles and that there is no inflammation in the ear. Patching is done with techniques such as underlay and overlay according to the way it is placed on the eardrum. To close the hole in the eardrum, ear cartilage, the membrane surrounding the cartilage, or both can be used for patching. In addition, the chewing muscle membrane located behind the ear can also be used for the patch. This surgery can be done in two ways, behind the ear or inside the ear. It is important that the hole formed in the eardrum is not large and the ear canal is wide for the operation to be performed inside the ear. The patch on the eardrum heals in about 2 to 3 weeks and integrates with the eardrum.
In the pre-operative period, patients should be careful not to get water in their ears. Until the day of surgery, patients should not get water in their ears and should not deal with ear cleaning. In this process, it is recommended to use tampons while taking a shower.
The surgery is performed in the form of local and general anesthesia. This differs according to the situation of the person. It is an operation that takes about 1-2 hours. After the operation, the patient is discharged from the hospital in one or two days. Although there is no age limit in this surgery, it is more appropriate to wait until the age of 12-14, since the development of congenital eardrum perforations continues. However, this is not the case in simple eardrum and cartilage surgeries, so it can be done at any age. The duration of the patient’s normal life is between 2-4 days. There may be mild pain after surgery. Painkillers are given for this. It takes an average of 6 months to wait for the hearing to fully recover. Time is needed for the swollen mucosa in the middle ear to recover, for blood to be absorbed and for the placed patch to adapt. Full recovery, especially after treatment and surgical intervention, can usually occur within eight weeks. After the closure of the ruptured eardrum, spongostan or similar materials are placed on the upper part of the membrane to stop the bleeding and fix the graft, but there is no need to remove the placed materials because they liquefy and melt. The materials used mix with the blood and may come out of the outer ear. Therefore, it is considered normal to have discharge in the ear during this process. In order to protect the ear from infection after the surgery, it is necessary to stay away from water for a while so that water is not lost. Antibiotic and cortisone-containing drops that the doctor deems appropriate should be used regularly. The patient can eat 3 hours after the surgery, but non-solid liquid foods should be consumed. If the eardrum surgery is performed from the back of the auricle, a pressure dressing can be applied to that area after the surgical procedure. In this process, dressing should be done every 5-6 days for 14-21 days.
It is necessary to protect the ear from impacts for the first month after the operation, and air travel should not be made. In order to reduce the blood pressure in the middle ear and behind the ear and the edema behind the ear, it is recommended that the patients lie down with their pillows elevated for the first week after the surgery. The mouth should not be kept closed while sneezing. Medication should also be taken when cough should not be present. For 8 weeks after the surgery, sports such as diving, swimming and water skiing should not be done and heavy exercises should be avoided. Since constipation will adversely affect the ear, you should drink plenty of water and eat fiber-containing foods during this period. The stitches are removed one week after the surgery. It is recommended to use earrings and piercings after the first month in order to prevent infection in patients who have undergone surgery. Again, in this process, the patient should stay away from loud environments. The eardrum should be well protected for 14 days after the surgery and water should not be missed. Shower should be taken so that water does not come to the head area. After this process, it is necessary to take a shower using ear tampons for the first 2 months. Very hot or very cold contact with the operated ear should be avoided and warm water should be preferred while taking a shower. Alcohol and tobacco products should also be avoided. Since smoking is a substance that reduces the healing rate and puts pressure on the upper respiratory tract, it should not be used for at least 1 month after the surgery. Ear rubbing should also be avoided as it may damage the eardrum after surgery. Conditions such as steam bath and solarium are beneficial to consult a doctor.