Burst Ear Drum (Burst
eardrum) in Adults
Disease/Disorder Name:
Perforation of the Eardrum
ICD-9 Description:
Perforation, Central, Tympanic membrane
Description:
Perforation of the eardrum is a rupture of the tympanic membrane. Also called a
"Burst Eardrum".
Causes of a burst eardrum
External Causes of a Burst Eardrum (most
frequent cause)
An external cause for a burst eardrum is a
head trauma such as a blow to the ear or an
object penetrating the ear canal and penetrating
the eardrum. An immediate trip to the emergency
room is mandatory. The following information
concerns minor eardrum damage fram an external
source with no penetration into the middle or
inner ear.
Usually, the larger the perforation, the greater the
loss of hearing. The location of the hole
(perforation) in the eardrum also effects the degree
of hearing loss. If severe trauma (e.g. skull
fracture) disrupts the bones in the middle ear which
transmit sound or causes injury to the inner ear
structures, the loss of hearing maybe quite severe.
With a traumatic or explosive event, the loss of
hearing can be great and ringing in the ear
(tinnitus) may be severe. In this case the hearing
usually returns partially, and the ringing diminishes
in a few days.
Side effects of a perforated eardrum (burst
eardrum) will definitely be excruciating pain.
You will probably also suffer from
vertigo and/or tinnitus
If a burst eardrum fails to heal (3-4 weeks) you may need a tympanoplasty to repair the eardrum. The perforated eardrum can also be treated by an operation called a myringoplasty,
where a tissue graft is used to seal up the
hole. These procedures are discussed below.
Internal Causes
of a Burst Eardrum - Otitis Media
Perforated eardrums from internal causes are
usually from
middle ear infections (otitis Media) (viral or bacterial).
Why? Detritus from the infection in the inner ear
(think bacteria or viral doo-doo) causes pressure to build in the middle ear
cavity and if not relieved by draining through
the Eustachian tube, the eardrum will
burst outward.
Symptoms of a burst eardrum from internal causes
- Sharp pain as the eardrum bursts, then initial
pain relief.
- Pus discharge from the ear, and usually very
smelly
- Bleeding
from the ear
- Hearing loss
- Tinnitus
- Vertigo
- Throbbing pain as the middle and inner ear is
subject to direct contact with the air
Outpatient treatments for a burst eardrum
OK. Your eardrum just burst . If you have had a
middle ear infection
that pushed out the eardrum, then the throbbing pain
has been greatly diminished. Wipe off the smelly
pus with a damp cloth, and lie quietly on your
stomach with your neck on a firm pillow and your
head turned so the ear that just burst is facing
downward. Place a warm, damp cloth, or a hot water
bottle wrapped in a towel underneath the ear.
Take one or two
ibuprofen (Tylenol® et al) or aspirin to minimize
the throbbing. Try to take a nap for an hour or two.
When you wake up or start to get up, stand up slowly
as you may have residual vertigo.
If you can tolerate a
few days of
associated vertigo, dizziness, and dull pain from
the open ear drum, you may not need to see a doctor
as the hole will in all likelihood heal on its own. It will depend on
the size of the hole, and the extent of the inner
ear infection. If you still don't feel good after
three days or if you still have a fever, it probably means the middle ear
infection is still present and needs to be treated.
Antibiotics are usually prescribed, sometimes initially by injection, then a regimen orally three times a day for at least 7 days.
In children, a penicillin-derivative called
amoxicillin or augmentine is often used.
Pediazole®, a brand-name combination of
erythromycin and sulfisoxazole can be used if you
are allergic to penicillin or
penicillin-derivative products.
Note:
In the past, antibiotics such as penicillin, erythrocyn, or erythromycin were prescribed. However, in the last few decades, many in the general population have become immune to the effects of these antibiotics, and stronger ones are often prescribed.
(The cause of immunity is often blamed on
the same antibiotics fed to the food supply (chickens and beef)) before they are brought to market.
The most common antibiotics in use today are doxycycline™ and Cipro™
If a hole in the eardrum does not close
naturally within two weeks, it should be closed
by other methods ASAP to prevent the possibility of water entering the ear while
showering, bathing, or swimming (which could
reinitiate an ear infection
or exacerbate an
already present ear infection).
The Healing Process for
a Burst Eardrum
As the eardrum heals and the opening closes, you will probably notice a
marked improvement in your hearing over the prior
days. Any vertigo, dizziness, tinnitus and pain should slowly abate.
A healthy healing eardrum may also prevent the development of
a cholesteatoma (skin cyst in the middle ear),
which can cause chronic infection and destruction of the
ossicles.
Small perforation - possible procedures:
- If the perforation is very small
and it does not heal after 2-3 weeks,
an ENT (Ear, Nose, and Throat specialist) may still decide not to operate and allow nature
to take its course and let the eardrum heal
naturally.
Myringoplasty (minor outpatient surgery)
-
There are a variety of surgical techniques
to close a hole from a burst ear drum, but basically
all procedures attempt to encourage the body to
heal the opening. Procedures performed through the
outer ear canal are called Myringotomies. This
type of surgery is typically quite successful in
closing most perforations permanently.
There are two types of
surgeons qualified to perform ear drum repair
operations: an ENT (Ear
Nose Throat surgeon), and Head and
Neck surgeons.
- A
myringoplasty is
usually done as a day-surgery local
or mild general anesthesia basis in about 20 - 30 minutes. The surgeon will
"clip" a small patch
from under the skin behind the ear. This layer is
called the dermis and is still "alive" and will
assist with the healing of the ear drum.
With small instruments, the surgeon will go
through the ear canal and delicately attach the
live skin tissue
to the outside of the hole. It will not completely
cover the hole to encourage new skin growth.
- Another
myringoplasty technique used to encourage a ear drum to heal is to add a chemical
(usually hyaluronic acid) to the edges of
the hole to stimulate growth and
instead of live tissue, a thin paper patch is
placed on the eardrum to
act as a basis for skin growth.
Several applications of
the patch (up to three or four over 3-6 weeks) may be required before
the perforation closes completely. If
these procedures are just not working,
surgery under general anesthesia is usually
recommended called a Tympanoplasty.
Tympanoplasty Surgical procedure (major surgery
in a hospital)
A tympanoplasty is performed under general anesthesia in
a hospital setting, and lasts 1 - 2 hours.
Photo Courtesy of The Internet Journal of
Otorhinolaryngology
A surgical cut is made behind
the ear, through the mastoid area.
Then the ear is moved forward to expose
the middle ear cavity, the back of
the eardrum and the front edge of the eardrum.
The eardrum is cleaned and the infected
area (if any) is cut away.
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The eardrum is is
pushed back by an instrument so the
surgeon can work on the back
of the eardrum.
The eardrum is cut with a scalpel
around the edges of the eardrum a
little over half the circumference.
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As with a myringotomy, a piece of tissue from
under the skin, and large enough to cover most
of the hole (a graft), is usually taken from
behind the ear and grafted onto the back of the eardrum.
First a foam gel is
inserted into the middle ear cavity to act as a
platform for the graft and to keep the ear drum
as still as possible.
The graft is inserted into the inside of the
eardrum where the edges of the hole are folded
back onto the perforation to close the hole.
The eardrum and graft rest on the foam gel. Surgical glue may be applied to keep the tissue
in place as it heals. After a few weeks the foam
gel is beaks down and is discharged out through
the Eustachian tube.
The Healing Process
After a
Tympanoplasty
Long Term
Effects of a Burst Eardrum on Hearing
The long term effects of a burst eardrum
and subsequent operations on the ear will be a
function of the size of the hole that was repaired,
and how many times the eardrum has to be worked on
before the hole is completely healed. With any
tissue that heals, there is scar tissue residue;
with any operation on body tissue, there is also
scar tissue residue. Scar tissue is the natural
end-result of a successfully healed eardrum.
The eardrum's purpose is to vibrate. the
buildup of scar tissue inhibits that vibration
function; the greater the scar tissue, the less the
eardrum will vibrate, affecting the ability to hear.
As a rule of thumb, a hole in the eardrum that heals
on its own within a few weeks or months will have
minimal effect on hearing. A myringotomy should only
affect hearing loss to a maximum of 5%; a
tympanoplasty can affect hearing negatively up to
20%. Then again if the surgeon does an
excellent job with a tympanoplasty and the hole is
relatively small, hearing loss will be negligible.
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