Vincent Pair Tympanic membrane (TM) perforation is an opening in the otherwise intact membrane that, as a mechanical component of hearing, separates the external ear from the middle ear. TM perforation results from a variety of conditions and is a cause of conductive hearing loss. Most perforations heal spontaneously without incident; however, some TM perforations may necessitate referral to a specialist. Perforation can be caused by a variety of traumatic, infectious, and neoplastic processes. The TM can be lacerated or perforated by foreign objects in the external canal. Barotrauma, physical trauma, blast injury, or a fracture of the temporal skull can tear or perforate the TM. On occasion, the TM perforates with the pressure and inflammation of acute otitis media. Perforations often precede the development of a cholesteatoma.1–4 A thorough history will support the cause of the TM perforation.1,4 TM perforations are often discovered at the time of trauma or during the evaluation for middle ear infection. Perforation may also be observed in association with a cholesteatoma. Most patients with traumatic perforation experience pain and some degree of hearing loss.5 A thorough ear examination and an evaluation of hearing status should be included in the initial assessment. After the perforation has healed, an audiogram is helpful in evaluating the presence or extent of hearing impairment. The differential diagnosis includes all causes of perforation, including trauma, infection, and neoplasm.
Tympanic Membrane Perforation
Definition and Epidemiology
Pathophysiology
Clinical Presentation and Physical Examination
Diagnostics and Differential Diagnosis
Tympanic Membrane Perforation
Chapter 87
