Damage to the eardrum
Damage to the eardrum is injury to the eardrum by mechanical, thermal, physical or chemical factors. This ailment is accompanied by pain and a feeling of stuffiness of the ear. Ear noise and hearing loss are other signs of damage to the eardrum. The clinical picture of these manifestations depends on how badly the ear was injured and what degree of damage occurred.
The content of the article:
Causes of damage to the eardrum
Signs of damage to the eardrum
Diagnosis of damage to the eardrum
Treatment of damage to the eardrum
Prognosis of damage to the eardrum
Damage to the eardrum
Usually, damage to the eardrum is diagnosed in the process of otoscopy or microtoscopy, as well as during the back-seeding of ear secretions.
As for the conservative treatment of such damage to the eardrum, it usually involves cleansing the ear canal of any foreign bodies or blood clots that have accumulated in it, and then implies its treatment with ethyl alcohol. Conservative treatment is also treatment with the use of antibiotics. If we talk about surgical treatment, it consists, first of all, in carrying out tympanoplasty or myringoplasty.
As you know, the eardrum is located at the very end of the auditory canal, separating it and the tympanic cavity of the middle ear. It consists of three layers: the outer one (it is a continuation of the epidermis of the skin of the auditory canal itself); the middle one (usually consists of circular, radial fibers) and the inner one (this is, in fact, the mucous membrane of the tympanic cavity).
The main function of the eardrum is to protect against ingress of water, air, microorganisms and foreign bodies into the middle ear. The second important function is sound transmission. The vibrations of the eardrum caused by sound waves are transmitted from it further along the chain of the existing auditory ossicles directly to the apparatus of the inner ear, which is responsible for sound perception. All violations of the protective and sound-conducting functions of this organ depend on the degree and nature of its damage.
It should be said that damage to the eardrum can also lead to its final destruction or partial rupture. The integrity of its individual layers can be violated even with minor injury, because any damage to the eardrum is, first of all, a violation of its integrity, which is dangerous, because it can lead to the development of infectious diseases in the middle ear cavity (acute otitis media, including purulent type, labyrinthitis, otomycosis and mastoiditis).
Causes of damage to the eardrum
If we talk about mechanical damage to the eardrum, then it is primarily associated with either an injury to the ear, or with a foreign body entering it, as well as unsuccessful attempts to extract a sulfur plug from the ear canal or use those objects for cleaning the ears that are completely not intended for this procedure. Damage to the eardrum may also be associated with a traumatic brain injury, which was accompanied by a fracture, for example, of the pyramid of the temporal bone, as well as a possible violation of the integrity of the tympanic cavity itself.
If we talk about physical factors that can contribute to damage to the eardrum, then these include, first of all, the pressure drop in the tympanic cavity itself and in the external auditory canal. Acoustic damage is possible in the event of a fall on the ear or a blow to the auricle, with a strong sneeze or during a person’s stay in the explosion zone. Also, acoustic damage can be the consequences of diving operations, jumping into the water from a great height. This type of damage can be the result of excessive stretching and have a different degree of severity, accompanied by aerosinusitis or aerotitis. Possible barotrauma can cause all kinds of structural disorders associated with individual layers or elements of the eardrum, which leads to damage to the vessel located in the eardrum itself. It is the barotrauma that can provoke the final rupture of the eardrum.
If we are talking about thermal damage to the eardrum, then usually these include burns of the auricle. Thermal damage may be of a domestic or industrial nature (for example, injury during pottery or blacksmithing). Chemical damage to the eardrum is usually caused by the ingress of various chemicals (for example, alkalis and acids) into the ear canal. Most often, it is chemical damage that leads to the final destruction of the eardrum, which means that a chemical substance enters the cavity of the middle and inner ear.
Signs of damage to the eardrum
At the moment when the damage to the eardrum occurs, a person feels a sharp characteristic earache. After some time, the pain syndrome subsides, but the person continues to complain of a sharp decrease in hearing and noise in the ear (or a feeling of ear congestion). If the damage to the eardrum was so severe that it led to its rupture, then a person can also feel the release of air from the injured ear. This happens during sneezing or blowing your nose.
It should be said that the severity of all clinical manifestations will primarily depend on the degree of damage to the eardrum. If the damage was minor and affected only the outer layer of the eardrum, then this will not lead to hearing loss. The latter will be characterized by a rapid regression of pain. But, if we are talking about extensive damage to the eardrum, then it is assumed that the auditory ossicles are fractured or the joints are torn. In practice, there is also injury to the internal muscles located in the middle ear cavity. However, most often there is a rupture of the joints (for example, the anvil of the stirrup), as well as a fracture of the base or legs of the stirrup. Impaired functioning in the auditory ossicle system can lead to the formation of conductive hearing loss. Intense noise in the ear and hearing loss are characteristic of fractures of the base of the stirrup. In this case, various vestibular disorders are also possible, accompanied by the outflow of perilymph from the ear cavity.
Diagnosis of damage to the eardrum
The primary diagnosis of a damaged eardrum is carried out by a traumatologist. The latter can be explained precisely by the fact that the damage is often associated with an ear injury. To establish a definitive diagnosis and determine the correct treatment, a consultation with an otolaryngologist is necessary. An effective method of diagnosing damage to the eardrum will be endoscopic examination, which includes otoscopy and microtoscopy. To determine the evaluation of the indicators of the hearing aid, as well as the vestibular, audiometry, tuning fork studies, threshold audiometry, electrocochleography, vestibulometry, stabilography and caloric sampling are carried out. Bacteriological examination of ear secretions is carried out if the damage to the eardrum is complicated by secondary infection.
Otoscopy in case of damage to the eardrum
In case of minor injury, otoscopy determines only the injection of the vessels of the tympanic membrane. Damage is more significant usually visualized in the form of subtotal defects, as well as rounded and point perforations, possible slit-like ruptures up to the complete destruction of the eardrum itself.
The rupture of the tympanic membrane is characterized by uneven scalloped edges. During otoscopy, a medial wall in the tympanic cavity can be observed in the membrane of the perforation. Otoscopy often helps to diagnose a hematoma that has appeared due to damage to the membrane, located in the tympanic cavity. Under the condition of acoustic or mechanical damage, the doctor may observe hemorrhages in the tympanic cavity. After a certain time, it is necessary to conduct a control otoscopy, which will be aimed at assessing those reparative processes that occur in the eardrum. It is the control otoscopy that is able to determine the scarring or the nature of the perforation. Sometimes, in the very thickness of the tympanic membrane, you can see a dense white formation, which is the deposition of calcium salts on the scar.
Treatment of damage to the eardrum
If the damage to the eardrum is not complicated by anything, then an unnecessary intervention will only cause harm. You do not need to wash the ear canal yourself, as well as bury the ear with drops. If necessary, then the doctor removes the foreign body from the ear canal. Blood clots should also be removed — they are removed using a dry cotton swab. The prevention of the disease will be the treatment of the auditory canal with ethyl alcohol. In the case of an inflammatory complication of the middle ear, a whole complex of antibiotics is usually prescribed. If the damage to the tympanic membrane was also complicated a second time, then the treatment takes place in accordance with the treatment of ordinary otitis media.
If, after undergoing treatment, a hole still remains in the previously damaged eardrum, then the doctor prescribes surgery to finally close this hole. The latter involves tympanoplasty or myringoplasty. The material for closing such a perforation hole is a chicken amnion or a meattimpanal flap. In recent years, the method of transplantation of specially cultured allofibroblasts has been used in the operation to close the hole. This method is applicable when the perforation hole is larger than half the size of the eardrum itself and does not heal within 2 weeks.
Prognosis of damage to the eardrum
Of course, the prognosis after treatment of a damaged eardrum will depend on the size of the damage. In 50% of cases, spontaneous recovery is observed. The best prognosis of spontaneous recovery and healing refers to slit-like ruptures of the tympanic membrane and perforations, the size of which is no more than 25% of the area of the tympanic membrane.
As you know, small injuries on the eardrum heal themselves, leaving no scars, whereas a large damage after recovery will have a characteristic scar. It is a massive scar and calcification of the eardrum that can lead to the onset of hearing loss.
If damage to the eardrum is combined with damage to the auditory ossicles, and is also accompanied by infection, then the prognosis of hearing restoration will be unfavorable. The latter suggests the occurrence of either adhesive otitis media, or inflammatory complications. A complication, for example, can lead to a persistent type of hearing loss, when the operation will no longer be possible to avoid if the patient wants to regain his hearing. The operation may also involve hearing replacement with the latest hearing aids.
Thus, if the damage to the eardrum is insignificant, spontaneous restoration of the damaged organ will occur, but if the hole in it is large, then surgical intervention is simply necessary, otherwise the patient risks not regaining his hearing.
