TYMPANIC

MEMBRANE INJURY

Features Symptoms Tx

Traumatic rupture Tympanic membrane may be ruptured by: -sudden deafness, -in majority of cases, edges of
(a) Trauma due to a hair pin, match stick or unskilled tinnitus, dizziness perforation get inverted towards
attempts to remove a foreign body. the middle ear.
(b) Sudden change in air pressure ; slap or sudden blast. Complication -ear should be examined under
Forceful Valsalva may rupture a thin atrophic membrane. -facial paralysis operating microscope and the
(c) Fluid pressure ; diving, water sports or forceful -subluxation of stapes edges of perforation repositioned
syringing. -nystagmus and splinted
(d) Fracture of temporal bone -sensorineural hearing
loss


Atrophic tympanic -serous OM ; middle fibrous layer gets absorbed leaving -normal tympanic
membrane a thin drumhead which easily gets collapsed with membrane consists of
eustachian tube insufficiency : outer epithelial
-perforation of tympanic membrane heals only by : middle fibrous
epithelial and mucosal layers without the fibrous layer : inner mucosal layer

Tympanosclerosis -hyalinisation and later calcification in the fibrous layer -chalky white plaque
of tympanic membrane -remains asymptomatic
- seen in CSOM ; complication of ventilation tube -interferes in the
conduction of sound
- tympanosclerosis mostly affect TM but may be seen
involving ligaments, joints of ossicles, muscle tendons
and submucosal layer of middle ear cleft

 Herpes zoster oticus -reactivation of dormant herpes zoster involving -appearance of vesicles
(Ramsay Hunt geniculate ganglion of facial nerve causing facial palsy on the TM, deep
Syndrome) and hearing loss meatus, concha and
retroauricular sulcus

Perforation Safe : central -usually from chronic OM
Unsafe : attic, marginal

Retracted TM -due to negative intratympanic pressure when -cone of light absent
Eustachian tube is blocked -handle of malleus
appear foreshortened

Symptoms
- Pain, acute and transient
- Conductive deafness ; cochlea may be damaged if stapes is driven into inner ear causing sensorineural deafness
- Tinnitus and persistent ; cochlear damage
- Vertigo ; rare
Signs
- Perforation
- Bleeding ; blood clot
Treatment for TM injury
- No cleaning
- No syringing
- No ear drops
- Antibiotics if there is infection
- Most traumatic perforations of eardrum heals by itself with no long term adverse effect (need follow up)
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