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 eardrum perforation is infection. Infections that occur in the ears, especially in children, are likely to pierce the eardrum. If the ear becomes infected, pus and similar fluids accumulate in the ear, which puts pressure on the eardrum. If this amount of pressure increases, then the ear may be pierced. Another condition that causes ear piercing is pressure. The body pressure at the back of the eardrum and the ear pressure at the front must be equal. Sudden changes in this pressure equation can cause the eardrum to perforate. These sudden pressure changes; It may occur during sudden altitude changes during airplane flights, water diving sports and land journeys. Injuries and blows are also important situations that can cause eardrum perforation. Applying excessive physical impact to the ear may damage the eardrum. Impacts and blows, cranial fractures, insertion of objects such as cotton swabs too far into the external ear canal, fluids that may be harmful to the ear entering the ear, and being in very noisy environments are all situations that may cause the eardrum to perforate. Apart from these, some people may have a perforated eardrum from birth.
Symptoms of perforated eardrum are as follows;
- Complete and partial hearing loss
- Ringing in the ear and Feeling of buzzing
- 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 pay attention to the situation when these symptoms are not very disturbing, but if they are not taken into consideration, hearing loss due to infection may occur, so anyone who experiences these symptoms should definitely consult a specialist ENT doctor.
Treatment of Eardrum Perforation
Most eardrum perforations heal on their own within a few weeks. However, in some perforations, the eardrum cannot repair itself and the perforation may be permanent. If the eardrum cannot repair itself within at least 6 weeks, then a surgical intervention may be required.
If there is excessive discharge from the ear, see your doctor. Your doctor first cleans 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 each time he hears the sounds. Treatments are primarily applied to reduce ear pain and eliminate the risk of inflammation. For this, first of all, medication is applied, and it is also recommended to apply a warm and dry cloth to the ear several times a day. It may be necessary to use antibiotics to treat or prevent ear infection. Antibiotics; In addition to treating intra-ear infections that cause perforation of the eardrum, it prevents infections that may occur with injury as a result of perforation of the eardrum. If the puncture causes pain, it is appropriate to also use painkillers. However, surgical intervention is required for 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 perforation is closed by covering the membrane with tissue and the patient's hearing loss is prevented. progression is prevented. Two techniques are used in surgical interventions for eardrum perforation: "Tympanoplasty" and "Myringoplasty". The size of the eardrum tear, the location of the tear, the structure of the ear canal, the patient's condition, and whether the mastoid bone will be intervened during the surgical procedure affect the surgery.
In surgeries performed with the tympanoplasty technique, the eardrum and the hearing system in the middle ear are repaired. Tympanoplasty is performed through incisions made inside the ear canal, behind the ear, or in the front part of the auricle. For repair of ruptured eardrum, an incision is made inside the ear canal or in the front part of the earlobe. If the mastoid bone will also be operated on, the operation is performed by making an incision behind the ear. Inflammation in the bone is also cleared. The tissue used to repair the ruptured or punctured eardrum is generally obtained from the sheath of the temporal muscle. Cartilage tissue that has undergone the necessary procedures for tissue repair Ready-made materials similar to eardrum pieces are also used. The patient's own tissues are usually used during the procedure. The surgery is determined according to the patient's condition and the operation is shaped accordingly. It can be performed only to repair the hole in the eardrum, to clean the inflammation that has progressed into the mastoid bone, to repair the ossicle system that provides sound transmission in the middle ear together with membrane repair, or to include all of these situations.
Another technique is myringoplasty surgery. This operation is performed when the eardrum does not repair itself within 6 weeks and there is no positive response to the treatments. Myringoplasty surgery is a patch procedure. It is a surgical intervention performed by covering small tears or holes in the eardrum with tissue. It is very important for this surgery that there is no problem with the ear ossicles and that there is no inflammation inside the ear. Patching is done with techniques such as underlay and overlay, depending on how it is placed on the eardrum. To close the hole in the eardrum, ear cartilage, the membrane surrounding the cartilage, or both together can be used for patching. Additionally, the chewing muscle membrane located behind the ear can be used for the patch. This surgery can be performed in two ways: behind the ear or inside the ear. For the procedure to be performed inside the ear, it is important that the hole in the eardrum is not large and the ear canal is wide. The patch applied to the eardrum heals in approximately 2 to 3 weeks and integrates with the eardrum.
Patients should be careful not to get water into their ears during the preoperative period. Until the day of surgery, patients should not get water into their ears or bother with ear cleaning. During this process, it is recommended to use tampons while taking a shower.
The surgery is performed under local and general anesthesia. This varies depending on the person's situation. It is a surgery that takes approximately 1-2 hours. After the surgery, the patient is discharged from the hospital within one or two days. Although there is no age limit for this surgery, it is more appropriate to wait until the age of 12-14 as development continues in congenital eardrum perforations. However, such a situation does not occur in simple eardrum and cartilage surgeries. It is not a matter of course, so it can be done at any age. The time it takes for the patient to continue his normal life is between 2-4 days. There may be slight pain after surgery. Painkillers are given for this. It takes approximately 6 months for hearing to fully recover. Time is needed for the swollen mucosa in the middle ear to recover, for the blood to be absorbed, and for the implanted patch to adapt. Full recovery can usually occur within eight weeks, especially after treatment and surgical intervention. After closing the ruptured eardrum, sponge or similar materials are placed on the upper part of the membrane to stop 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 blood and can come out of the outer ear. Therefore, it is considered normal to have discharge in the ear during this period. After the surgery, water should be avoided for a while to protect the ear from infection. Antibiotic and cortisone-containing drops deemed appropriate by the doctor should be used regularly. The patient can eat 3 hours after the surgery, but liquid, non-solid foods should be consumed. If the eardrum surgery is performed from the back part of the earlobe, a pressure dressing can be applied to that area after the surgery. During this process, dressings need to be done every 5-6 days for 14-21 days.
The ear should be protected from impacts for the first month after the surgery and plane travel should not be done. In order to reduce the blood pressure in the middle ear and behind the ear and the edema behind the ear, patients are advised to sleep with their pillows elevated for the first week after surgery. The mouth should not be kept closed while sneezing. Medicine should be taken even when there is no cough. Sports such as diving, swimming and water skiing should not be done and heavy exercises should be avoided for 8 weeks after the surgery. Since constipation will negatively affect the ear, you should drink plenty of water and consume fiber-containing foods during this period. The stitches are removed one week after the surgery. It is recommended for patients who undergo surgery to use earrings and piercings after the first month to prevent infection. Again, during this process, the patient should not be exposed to loud environments. must stay away from now on. The eardrum should be well protected for 14 days after surgery and water should not be lost. Shower should be taken in a way that does not get water on the head area. After this process, it is necessary to take a shower using ear tampons for the first 2 months. Contact with the operated ear should be avoided from being too hot or too cold, and lukewarm water should be preferred when taking a shower. Alcohol and tobacco products should also be avoided. Since smoking is a substance that slows down 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 after surgery as it may damage the eardrum. It is beneficial to consult a doctor for situations such as steam bath and solarium.
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