Eardrum perforation

Introduction Tympanic membrane perforation In the otolaryngology clinic, various types of tympanic membrane perforation patients are often seen. Some are perforated with acute otitis media due to a cold, or accidentally digging through the ear. Some infants and young children suffer from improper breastfeeding, causing pus in the ear after vomiting, and even being hit by the ball or hand when playing the ball. The quarrel is slap in the face, and the firecrackers can also cause perforation of the tympanic membrane. Occasionally, insects can be seen in the ear to cause perforation of the tym

Cause

1. The tympanic membrane is located in the deepest part of the ear canal and has certain elasticity and toughness. It is not easy to be damaged or perforated under normal conditions. The direct cause is more common in the head trauma, combined with tympanic membrane damage to the tympanic membrane. On the other hand, there are ear-picked feeds, which are used too hard or collide with others to pierce the tympanic membrane. Secondly, the factory mine occasionally splashed metal powder, slag, electric welding sparks and mis-drip etchants, such as strong acid, strong alkali corrosion tympanic membrane perforation.

2, indirect tympanic membrane trauma, common in sudden changes in atmospheric pressure, such as shells, shooting, loud noise, air waves will break the tympanic membrane. Usually slap in the face can also damage the tympanic membrane, perforation occurs, the air pressure in the middle ear cavity rises sharply, and the internal and external air pressure imbalance occurs. Such as forceful nose and other reasons.

3, the most common cause of tympanic membrane perforation, is caused by the direction of the eustachian tube, and more common in infants and young children, because the infant eustachian tube wide, short, straight, anatomical features, easy to think of acute otitis media, resulting in tympanic membrane perforation.

an examination

Related inspection

Otolaryngology CT examination Eustachian tube fluorescein test tympanic membrane

1. Pure tone hearing threshold examination: pure tone hearing threshold is the basis for monitoring the progress of otological diseases, evaluating the curative effect, selecting prevention and treatment - rehabilitation measures, evaluation of disability, and forensic identification. The use of standard audiometers for hearing tests is a widely accepted and widely accepted method of examination that accurately reflects the sensitivity of hearing. Through this check, the patient's sensitivity to sound can be detected. Ear endoscope

2, ear endoscopy: endoscope is an optical instrument, sent from outside the ear canal, examination of the eardrum tympanic membrane disease, you can directly observe the ear canal, tympanic membrane depression, perforation, etc., determine its location, The range, and can be photographed, biopsied or brushed, greatly improving the diagnostic accuracy of conductive deafness, and can check the corrosion of the hearing aid horn.

3. Check the function of the eustachian tube: The eustachian tube is a tube that communicates the tympanic cavity and the nasopharynx. Its function is closely related to the physiological function of the middle ear, which is of great significance for the prevention and treatment of middle ear disease. There are usually 3 ways:

1Pressing the nasal air (Valsalva) method: After the patient inhales, pinch the nostrils on both sides with your fingers, close the mouth, and forcefully exhale from the nose, so that the pharyngeal air can be flushed into the eustachian tube.

2 balloon stripping (Politzer) method: the patient's mouth contains water, the olive head with the eustachian tube blowing the ball is inserted into the pupil of one side of the patient, and the other nostril is pressed by the finger, and the sphere is pressed while the water is swallowed. Air can be flushed into the Eustachian tube.

3 catheter blowing method: the patient takes a seat, cleans the nasal secretions, and then inserts the eustachian tube elbow down the bottom of the nose, and reaches the posterior wall of the nasopharynx, then turns to the outside 90°, then pulls forward slightly. The catheter is slid over the bulge and slid into the mouth of the eustachian tube. The catheter is fixed, and the air is injected through the catheter with a blown ball. At the same time, the ear can be heard by the ear to check whether the eustachian tube is patency or not.

Differential diagnosis

The diagnostic points for tympanic membrane perforation are:

(1) A history of ear or head injuries.

(2) With earache, deafness, and a small amount of bleeding in the external auditory canal.

(3) The shape conforms to the characteristics of traumatic perforation: the perforation is mostly located in the tension part, which is fissure-like, triangular, irregular, etc., the perforation edge is sharp, everted, and bloody.

(4) The acoustic impedance test cannot lead to the tympanogram, or the injured ear is B-shaped but the external auditory canal volume is significantly larger than the healthy ear.

(5) Exclude perforation caused by otitis media. Acoustic impedance and ear endoscopy can objectively and truly reflect the morphological features of the tympanic membrane perforation, and can provide an objective basis for the forensic identification of traumatic tympanic membrane perforation.

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