Tympanic Membrane Perforation in Children

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

A tympanic membrane perforation, commonly referred to as a ruptured eardrum, is a tear or hole in the thin tissue that separates the ear canal from the middle ear. In children, this condition can occur due to infections, trauma, or sudden pressure changes. It can result in hearing loss, pain, and increased risk of ear infections.

Aetiology

Tympanic membrane perforation in children can result from various causes, including:

• Middle ear infections (acute otitis media): Fluid build-up due to infection can cause increased pressure, leading to the rupture of the tympanic membrane.
• Trauma: Direct injury to the ear, such as inserting objects like cotton buds, or exposure to a loud noise or explosion (acoustic trauma), can lead to perforation.
• Barotrauma: Sudden changes in pressure, such as during air travel or diving, can cause the eardrum to tear.
• Chronic ear infections: Long-standing infections can weaken the eardrum and make it more susceptible to perforation.

Pathophysiology

The tympanic membrane serves as a barrier between the external ear canal and the middle ear. It also helps transmit sound waves to the ossicles (small bones) in the middle ear, which send auditory signals to the brain. When the membrane is perforated, the normal function of the eardrum is disrupted, leading to hearing loss and increased risk of infections. The tear may heal spontaneously, depending on the size and cause, or may require medical intervention.

Risk Factors

• Recurrent ear infections (otitis media).
• Use of foreign objects to clean the ear canal.
• Participation in activities involving sudden pressure changes, such as diving or flying.
• Exposure to loud noises or explosions.
• History of previous tympanic membrane perforation or ear surgery.

Signs and Symptoms

Common signs and symptoms of tympanic membrane perforation in children include:

• Sudden sharp ear pain, which may subside after the membrane ruptures.
• Hearing loss in the affected ear.
• Ear discharge, which may be clear, bloody, or pus-like, especially if there is an infection.
• Tinnitus (ringing or buzzing in the ear).
• Vertigo or dizziness, especially in cases involving trauma or barotrauma.
• Fever, if the perforation is due to an underlying infection (acute otitis media).

Investigations

Diagnosis is usually made through clinical examination and may involve:

• Otoscopy: A visual examination of the ear using an otoscope can reveal the size and location of the perforation.
• Pure Tone Audiometry: A hearing test may be conducted to assess the degree of hearing loss.
• Tympanometry: This test measures how well the eardrum moves in response to changes in air pressure in the ear canal.
• Ear swab culture: In cases of chronic discharge, a swab may be taken to identify any bacterial infection.

Management

Treatment depends on the size of the perforation, the underlying cause, and the presence of infection:

Conservative Management:

• Observation: Small perforations often heal spontaneously within a few weeks, particularly if the underlying infection is treated.
• Antibiotic: If the perforation is associated with infection, oral antibiotics can be prescribed
• Keeping the ear dry: It's essential to avoid water entering the ear, as this can delay healing or introduce infection.

Surgical Management:

• Myringoplasty: For larger or persistent perforations, surgical repair of the eardrum may be necessary to restore hearing and prevent further infections.
• Tympanoplasty: In cases involving damage to the middle ear structures, more extensive surgery may be needed to reconstruct the eardrum and ossicles.

Follow-Up and Monitoring:

• Regular follow-up appointments are necessary to ensure the perforation heals correctly.
• Hearing tests may be repeated after the membrane has healed to assess any lasting effects on hearing.
• If recurrent infections or complications arise, referral to an ENT specialist is recommended.

References

1. NICE (2024). Ear Infections and Perforation Management. Available at: NICE Guidelines
2. NHS (2023). Tympanic Membrane Perforation in Children. Available at: NHS Website
3. British Medical Journal (2023). Diagnosis and Management of Ear Perforations in Children. Available at: BMJ