What are the traumatic and iatrogenic causes of tympanic membrane perforation (TMP)?

Updated: Dec 14, 2020
  • Author: Robert A Saadi, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Traumatic perforations may result from blows to the ear (eg, being struck with the flat of the hand; falling from water skis with the head hitting the water surface, ear down). [11] Exposure to severe atmospheric overpressure from an explosion can tear the drum. [12] TMP from water pressure occurs in scuba divers, usually in a drum with atrophy from previous disease. Objects used to clean the ear canal can perforate the drum (ie, cotton swab trauma).

Inexpertly performed irrigation of the ear canal for wax can lead to perforation. In some settings, when irrigation for cerumen is relegated to medical assistants, otolaryngologists may see 10-20 patients per year with this injury. Evidence exists that such perforations are less likely to heal spontaneously. [13]

TMP is intentionally created whenever a surgeon makes an incision in the eardrum (myringotomy). When pressure-equalizing tubes (ventilating tubes) are placed, the TMP purposely is held open. Failure of surgically created openings to heal when the tube extrudes results in chronic TMP. Roughly 1% of patients who undergo a myringotomy with ventilation tube insertion will develop a chronic perforation. [14] In some patients with chronic eustachian tube dysfunction, however, the presence of a dry, chronic perforation may actually be helpful for ventilation. 


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