Tympanic Membrane Perforation

WHAT YOU SHOULD KNOW:

• Your tympanic membrane, or eardrum, is a stiff but movable oval membrane inside your ear. Your tympanic membrane separates your outer ear canal from your inner ear. A tympanic membrane perforation is a condition where your eardrum has a tear or hole in it. You may have normal or decreased hearing when your eardrum is torn. You may also have ear discharge, tinnitus (ringing or buzzing sound in the ear), or dizziness. Ear discharge may be clear, bloody, or yellowish and thick.
  
  
• A mild eardrum perforation may heal on its own over time. Your caregiver may clean your ear, put a bandage over it, or place a cotton ear plug in your ear. Your eardrum may heal completely within a few weeks to a few months. You may need antibiotic medicine to treat or prevent an ear infection. If medicines do not work, you may need surgery such as a tympanoplasty or myringoplasty. Both surgeries are done to repair your eardrum hole using a tissue graft. A tympanoplasty is done if you also have damage to your inner ear. Treating your tympanic membrane perforation may resolve your symptoms, improve your hearing, and prevent further ear infections.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

• Medicines used to treat your tympanic membrane perforation may cause dizziness, vomiting (throwing up), or loose bowel movements. Medicines may also cause an allergic response and you may have trouble breathing. Ear drop antibiotics may damage your inner ear if you use them for longer than ordered. Surgery may cause you to have bloody discharge from your ear. Surgery may also cause you to have ear pain and you may get an infection. The tissue graft used to cover the hole in your eardrum may also become infected.
  
  
• Not treating your perforated eardrum may cause worsening or permanent hearing loss. You may have chronic repeat ear infections. The tear or hole in your eardrum may get bigger. Water may enter through the hole in your ear causing infection and damage to your inner ear. You may not be able to do activities you enjoy such as swimming, diving or surfing. A severe ear infection may spread to your head, neck, and brain, and you may die.

WHILE YOU ARE HERE:

Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.

Vital signs: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope. Your vital signs are taken so caregivers can see how you are doing.

Medicines: Your caregiver may give you the following kinds of medicines:

• Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria. Antibiotics may be taken by mouth or given as liquid drops in one or both of your ears.
  
  
• Pain medicine: Caregivers may give you medicine to take away or decrease your pain. Medicine may be given regularly, or may only be given if you ask caregivers for it. Tell caregivers if your pain does not decrease enough for you to feel better. Do not wait to ask for your pain medicine until the pain is very bad. The medicine may not work as well at controlling your pain if you wait too long to take it. Ask your caregiver for help getting out of bed if you feel tired or dizzy.

Tests:

• Culture: If you have ear discharge, your caregiver may collect it to check for bacteria. A culture may help your caregiver decide which medicine would best treat your infection.
  
  
• Ear tests:
  
  
  • Audiometry: This hearing test checks how sensitive your ears are to sounds at different volumes. The hearing tests may include pure-tone audiometry and speech audiometry tests. The tests help measure the quietest sounds or speech that you can hear. They also help measure how well you understand words when they are spoken at a normal sound level. These tests may check your type of hearing loss and how bad your hearing loss is.
    
    
  • Otoscopy: Your caregiver may use a special tool called an otoscope to check your eardrum. An otoscope helps your caregiver see inside your ear. With an otoscope, your caregiver can see the location and size of the hole in your eardrum clearly. Your caregiver may also look for any fluid or infection inside your ear.
    
    
  • Tuning fork test: For this test, a vibrating tuning fork is held against the bone behind your ear. The tuning fork may also be held against your forehead, nose, or outside the opening of your ear. You will be asked if you can hear certain sounds. Your hearing may be tested holding the tuning fork in more than one place. When this is done you will be asked to state which area you heard the sound best. The tuning fork test can help your caregiver learn what type of hearing loss you have.

Treatment options:

• Surgery: You may need surgery to repair your eardrum and prevent future ear infections. This is done when the hole in your eardrum is large, or does not heal on its own. You may also need surgery if your hearing loss or ear discharge does not get better with medicine. Ask your caregiver for more information on the following:
  
  
  • Myringoplasty: This type of surgery uses a tissue graft to cover your torn eardrum. A tissue graft may be taken from your own body, another person, an animal, or is man-made. A procedure called a mastoidectomy may also be done with a myringoplasty. A mastoidectomy is removal of infected bone from behind your ear. A mastoidectomy may also help prevent your eardrum from breaking down.
    
    
  • Tympanoplasty: This surgery repairs your torn eardrum and any damage to your inner ear. A tympanoplasty also helps prevent ear infections that stop and come back. The hole in your eardrum will be covered with a tissue graft. You may also need to have a mastoidectomy with your tympanoplasty surgery.
  
  

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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