Reference:
- Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 15th Edition, ISBN 978-197-51-6103-3, by Janice L. Hinkle, Kerry H. Cheever, and Kristen J. Overbaugh (Ch. 59, pp. 1935-1963)
Perforation caused by infection (rupturing from middle ear pressure) or trauma. These include skull fractures, injury from explosion, or severe blows to the ear. Less frequently, these can be caused by foreign bodies that have been pushed too far into the external auditory canal. Injury to the ossicles and even the inner ear can be associated with tympanic membrane perforation.
Treatment
Most perforations heal spontaneously within weeks, or months. Some persist when scar tissue grows on the perforation, and prevents extension of the epithelial cells across the margins and final healing.
- In cases of head injury or temporal bone fracture, a patient is observed for CSF otorrhea or rhinorrhea.
- While healing, protect the ear from water entering the ear canal.
Surgical management (Tympanoplasty) can be done for prevention of infection or to restore hearing. It is performed on an outpatient bases and can be done with various techniques; grafting (usually from temporalis fascia) can allow healing and closing the perforation permanently, and improving hearing.