Burst of the eardrum: symptoms, treatment and consequences
Jun 01, 2018
Currently, in ENT practice, ruptures of the tympanic membrane( tympanic membrane) are diagnosed quite often.Among the victims - both adults and children.There are a number of factors that lead to damage, some of which do not depend on the patient in any way.This type of injury causes a sharp decrease in hearing.
Note: The function of the tympanic membrane - a thin leathery membrane that separates the middle ear and auditory meatus - consists in transferring air vibrations to the auditory ossicles.Contents: reasons pathology Symptoms eardrum rupture Possible consequences of rupture of the eardrum Diagnosis Treatment of rupture of the eardrum
The main causes membrane rupture include:
- local inflammatory process;
- effect of pressure( barotrauma);
- strong noise;
- mechanical trauma( incl. During hygiene procedures);
- ingress of foreign bodies into the auditory meatus;
- thermal exposure;
- chemical damage;
- trauma of the skull( BCC, accompanied by a violation of the integrity of the temporal bone).
Many patients do not rush to the ENT doctor, noticing the first signs of otitis( inflammation of the middle ear), and engaged in self-medication, using questionable "folk recipes."The code develops suppuration, then purulent exudate accumulates and presses on the membrane.If the problem is not eliminated in a timely manner, then a significant amount of pathologic detachment can completely lead to rupture of the membrane.In addition, the membrane is capable of gradual purulent fusion.
A significant pressure drop is observed with a quick immersion in water, sneezing with a clamped nose, and also in an airplane on the first seconds of climbing .A great danger for the tympanic membrane is a sharp intense noise and a nearby explosion - in such cases the membrane is simultaneously affected by a strong airflow and a difference in pressure.Divers( divers) with rapid ascent from the depth often suffer from damage to the tympanic membrane( so-called "reverse rupture").This is one of the symptoms of caisson disease, accompanied by the appearance of blood from the ears.
A frequent cause of perforation or rupture of the membrane is a self-inflicted trauma caused by the patient during the cleaning of the ear canal with unsuitable objects - knitting needles, toothpicks, pins, etc. .Often the mucous membrane of the middle ear is damaged in parallel, which leads to secondary bacterial complications due to infection.
Note: many people injure the membrane and the mucosa of the auditory canal, trying to get rid of sulfuric cork at home.Remember that extracting it using improvised tools is not only inefficient, but also very dangerous.
On a harmless hygiene item( cotton swab), a small solid foreign body with sharp edges may accidentally appear.With rotational movements, the membrane is often injured.
Important: small children left unattended by adults can insert a pencil or other solid object that could damage the eardrum during the game.
The burst of the membrane due to thermal exposure is possible in persons working in hot shops( for example - at metallurgical plants).
Damage to the tympanic membrane is often diagnosed in severe CCT, associated with a fracture of the temporal bone.
To injury can cause a blow to the auricle with an open palm or even a kiss in the ear.
Symptoms of rupture of the tympanic membrane
Leading symptoms of rupture:
- intense pain;
- marked disturbance of acuity of auditory perception;
- sensation of tinnitus;
- feeling of "stuffiness" in the damaged ear.
At the time of injury, the patient feels the greatest pain.The intensity of the pain syndrome is so great that a person can darken in the eyes, and even develop a short-term fainting condition.
The pain is gradually decreasing, but other clinical signs clearly evidencing damage to the membrane develop.The victim clearly feels that he began to hear much worse than before the time of injury.In parallel, the noise in the ears grows, and, this process is completely impossible to control.
Important: , individual patients complain that at the time of blowing they feel like air coming out of the ear from the side of the injury;This phenomenon is due to the fact that internal structures of the hearing organ have temporarily lost protection.
Problems from the side of the vestibular apparatus( for example, instability in the vertical position or unsteadiness of the gait) are noted if the auditory ossicles are affected.
If the cause of the violation of the integrity of the tympanic membrane was an explosion that occurred nearby, then the trauma in most cases is accompanied by bleeding from one or both ears.It unequivocally speaks about serious damage of tissues( including - blood vessels).
Possible consequences of rupture of the tympanic membrane
Among the complications of rupture of the tympanic membrane is an infectious inflammation of the inner ear, which was left without a natural barrier on the way of pathogenic microflora. Infectious complications include:
- otitis media;
- neuritis of the auditory nerve.
Inflammatory process affecting the tissues of the inner ear( labyrinthitis) is accompanied by nausea, vomiting and pronounced dizziness.The defeat of the auditory nerve is manifested by an intense pain syndrome.
If timely not to take all possible measures to eliminate the infectious process, it extends to the brain tissue and leads to the development of meningitis or encephalitis, and this already poses a serious threat to the life of the victim.
In case of significant damage, when in some cases even surgical intervention is required, there is a risk that the acuity of auditory perception in the damaged ear will not be restored by 100%.
If you have any signs that you suspect a violation of the integrity of the tympanic membrane, you should immediately contact the nearest injury center or an otolaryngologist at the local polyclinic.
General examination, palpation and patient interview usually do not allow an objective assessment of the severity of the injury.The victim may be in a state of shock, which makes it difficult to collect an anamnesis.
For the internal examination, a special medical instrument is used - the otoscope.With its help, the degree of damage to the membrane and the presence of pus in the area of damage are revealed.At the same time, audiometry tests are conducted to determine the degree of hearing loss from the damaged side.
For subsequent laboratory tests, a leakage of fluid from the ear is taken.Its analysis is necessary to identify the possible presence of pathogenic microflora, which can cause further complications.
Tests will also be required to determine the presence of vestibular disorders.
For CTBT, an X-ray examination is mandatory to detect fractures of the skull bones( in particular, the temporal).
Only a comprehensive examination makes it possible to verify the diagnosis and prescribe adequate treatment.
Treatment for ruptured eardrum
Depending on the nature and severity of the injury, as well as on the presence of complications, conservative( medical) therapy or surgery is used.
In most cases, the damaged eardrum can recover itself. With a small area of rupture, regeneration proceeds fairly quickly.The patient is strongly recommended to observe a bed or half-bed regime, and in no case should he resort to any independent manipulation of the aural canals.
For an insignificant rupture, the ENT doctor places a sterile paper bandage-patch.It is replaced every 3-4 days. In most cases, 3 to 5 procedures( dressings) are required.The main task of such conservative treatment is the prevention of infection and the acceleration of reparative processes.
If contamination or blood clots are detected in the ear during an initial visual examination, they are removed with a sterile cotton swab.Then the affected area is washed with an antiseptic( usually a solution of medical alcohol).Cauterization with drugs of chromic acid and silver nitrate is often required.In the ear canal they are not poured - only careful external treatment is carried out.At the end of the manipulations, a tight tampon of sterile cotton wool is inserted into the auditory canal( it is also subject to periodic replacement).
To prevent infectious complications, the otolaryngologist will appoint special ear drops, which include an antibacterial component( antibiotic) and an anti-inflammatory drug.
- Sofraks( active substance - antibiotic neomycin);
- Candybiotic( a complex preparation against fungi and bacteria);
- An otinum( anti-inflammatory agent);
- Otypax( the composition includes an anesthetic lidocaine and a steroid for stopping inflammation);
- Otofa( contains broad-spectrum antibiotic);
The indication for surgery is a large area of rupture of the tympanic membrane or inefficiency of pharmacotherapy.
Surgical intervention( myringoplasty) is performed exclusively under anesthesia.Even a patient with a very high pain threshold can not tolerate pain, which persists even with very good local anesthesia.
During surgery, a small incision is made behind the ear, from which an autoplant is taken - a fragment of its own tissue to replace the defect.The flap is fixed to the damaged membrane by means of an endoscopic instrument.For the application of seams, a material is used which, over time, undergoes biodegradation, i.e., independently dissolves( in about 2 weeks).After the end of manipulation, the auditory canal is plastered with a turunda with an antibiotic solution.
In the postoperative period, the patient is forbidden to inhale deeply and exhale through the nose in order to avoid displacement of the autoplane.
To expedite the process of tissue repair, it is advisable to consume more ascorbic acid.Vitamin C is abundant in citrus and broths of hawthorn and dogrose.
Forecast and prevention
If the rupture of the tympanic membrane is diagnosed in time and the treatment is performed adequately and in full, then in most cases a full recovery will occur and the hearing will be fully restored.
With secondary bacterial complications, the prognosis is somewhat less optimistic, and the treatment continues for quite a long time.
Basic preventive measures:
- should not use air transport for ENT diseases in the acute phase;
- does not need to try to remove sulfur fuses;
- for the hygiene of the ear can only use special cotton swabs( with caution);
- Inflammation of the middle ear( otitis media) is important to treat immediately after the appearance of the first signs of the disease;
- , if possible, avoid staying in places with high noise levels or use earplugs;
- do not self-medicate - it almost always leads to complications.
Please note: While in the cabin of the , wear headphones during acceleration and take-off.Pick up the candy( in most airlines they are immediately distributed by the stewardesses);With each swallowing movement air enters the cavity of the middle ear through eustachian tubes.It is important to adhere to similar tactics when decreasing, when pressure equalization occurs.The easiest way to avoid barotrauma is to open your mouth.
Vladimir Plisov, medical reviewer