Perforated Tympanic Membrane
Perforated tympanic membrane could be due to a lot of causes which includes acute middle ear infection, chronic middle ear infection, traumatic injury, blast injury, barotrauma especially when diving and foreign body especially living insect or iatrogenic during removal of the foreign body.
In persistant chronic ear discharge which is non resolving with tympanic perforation, the more serious diseases or diagnosis have to be worked out. Chronic mastoiditis or cholesteatoma are among the common diagnosis which might cause chronic ear discharge. Treatment of the tympanic perforation in this two conditions are to treat the chronic infection or eradication of the reservoir and removal of all the cholesteatoma and disease air cell in operation. After the successful treatment of the underlying diseases, then tympanic membrane could be repaired subsequently.
In dry ear with tympanic membrane perforation, the risk of recurrent infection especially during water activity is much higher and each ear infection might expose the risk of patient to more serious complications such as labyrinthitis, brain meningitis, brain abscess, facial nerve palsy, sensorineural hearing loss and mastoid abscess.
The repair of the tympanic membrane is encourage to prevent risk of further ear infection. Besides, in certain cases the repair of the ear drum might be helpful in improving conductive hearing loss in certain degree.
The repair of ear drum is called myringoplasty or tympanoplasty type I where the ear drum perforation is trimmed and a graft is laid whether on top of the ear drum perforation or under the ear drum perforation. The healing of the ear drum will take place naturally with the help of graft to act as a platform for the new cell to grow over. Hence the success of the operation not only depend on the surgery per se, its also depend on the ear care post operatively. The ear drum could be repaired using microscopic or the latest technique of endoscopic approach.