Perforated Eardrum - Definition, Causes, Symptoms, Treatment

Tympanic Membrane Perforation

Ruptured eardrum - Traumatic ear drum perforation - Treatment of perforated eardrum - Eardrum reapir Istanbul - Eardrum repair Turkey - Eardrum surgery in Istanbul - Eardrum hole operation in Turkey

A perforated eardrum (or "perforations of the tympanic membrane (eardrum)") is defined as "a hole or tear in the eardrum".

There are two separate functions of the tympanic membrane:

- First, the sound waves that hit the vibration surface
- Second, is the barrier that separates the outer ear and the middle ear cavity.

Ear Anatomy

Anatomy of the ear - Image source: University of Minnesota Duluth

Our ear consists of three separate anatomical regions: outer, middle and inner ear. There are different structures that provide sound transmission from the outer ear to the inner ear. The sound waves carried to the eardrum by the auricle and the outer ear vibrate the eardrum. The vibrating eardrum transmits vibration energy to the ossicles in the middle ear immediately adjacent. The ossial system, which acts as a lever and the vibration energy generated by the sound waves, is transmitted to our inner ear by increasing. The vibration transmitted to the inner ear stimulates the cells in different regions and provides the perception of different sounds with the nerves going from here to the brain. That is, any disease or condition that prevents or interferes with the transmission of a sound between the outer ear and the inner ear can cause hearing loss. In diseases and other conditions affecting our outer and middle ears, the sound cannot be transmitted to the inner ear. This type of hearing loss is called conductive hearing loss. In the diseases and conditions related to the inner ear, although the sound transmission; This type of hearing loss is called neural (sensorineural) hearing loss because there will be no detection of vibrations transmitted to the inner ear.

In this delicate balance of the ear, besides the task of detecting and distinguishing the sound waves, the eardrum has the task of forming a barrier between the outer ear and the middle ear.

A simple hole in the eardrum may cause recurrent middle ear infections; It may cause problems such as disruption of middle ear ossicular structures, death of inner ear nerve cells and spread of infection to brain and vessels.

Perforated Eardrum - Definition, Causes, Symptoms, Treatment

The region of the middle ear is very close to the brain and large vessel structures. Ear anatomy and surgical experience need to be known in order to perform these operations.

In all surgical procedures for this region, as in the middle ear inflammation; There are several risks of neural injury. Especially in patients with chronic otitis media (chronic otitis media), changes in middle ear structures, bone structures may be melting. This requires the surgeon to be more careful during middle ear surgery and use a high-quality, high-resolution surgical microscope.

In the presence of cholesteatoma (inflammation foci in the middle ear that can melt the bone structures) that may sometimes coexist with chronic otitis media, there may be dissolution of the middle ear bone and ossicular structures. Sometimes, in this case, because the bone canal on the facial nerve may be fused, there is a possibility that this structure may be damaged during middle ear surgery.

Perforated Eardrum Due to Middle Ear Infection

An infection of the middle ear is one of the most common causes of a perforated eardrum. Chronic middle ear infection can cause to tympanic membran perforation and structural changes on middle ear.

Large Central Tympanic  Membrane Perforation
The photograph above shows a large central tympanic membrane perforation, which was detected during the otoscopic examination of the patient with previous middle ear infections. In this patient, conductive hearing loss is more common due to the almost complete loss of the surface area, that is, the eardrum, where the sound waves multiply and vibrate. At the same time, due to the deterioration of the barrier function between the middle ear and the outer ear, the risk of recurrent middle ear inflammation may be higher after water contact with the ear.

Perforated Eardrum Due to Trauma

Ruptured eardrum - Traumatic ear drum perforation - Treatment of perforated eardrum - Eardrum repair Istanbul - Eardrum repair Turkey - Eardrum surgery in Istanbul - Eardrum hole operation in Turkey
Perforated Eardrum Due to Trauma
Ruptured eardrum - Traumatic ear drum perforation - Treatment of perforated eardrum - Eardrum repair Istanbul - Eardrum repair Turkey - Eardrum surgery in Istanbul - Eardrum hole operation in Turkey

A perforated eardrum is sometimes caused by a trauma to the eardrum. Traumatic causes which can cause tympanic membrane rupture are:

- Injury
- Loud noises
- Barotrauma
- Surgical trauma (such as after grommet ventilation tube insertion)

Perforated Eardrum After The Failed Ear Drum Surgery (Myringoplasty or Tympanoplasty)

Ruptured eardrum - Traumatic ear drum perforation - Treatment of perforated eardrum - Eardrum repair Istanbul - Eardrum repair Turkey - Eardrum surgery in Istanbul - Eardrum hole operation in Turkey

Eardrum surgeries performed for tympanic membrane perforation closure. However, sometimes infection, trauma or lack of surgical technique can cause graft failure and therefore failure to heal the eardrum.

Photo above at the posterior of the ear drum, the graft is immediately adjacent to the hole.

Perforated Eardrum - Symptoms

Ruptured eardrum - Traumatic ear drum perforation - Treatment of perforated eardrum - Eardrum repair Istanbul - Eardrum repair Turkey - Eardrum surgery in Istanbul - Eardrum hole operation in Turkey
Perforated Eardrum - Symptoms
Ruptured eardrum - Traumatic ear drum perforation - Treatment of perforated eardrum - Eardrum repair Istanbul - Eardrum repair Turkey - Eardrum surgery in Istanbul - Eardrum hole operation in Turkey

Eardrum perforation can cause some symptoms. Hearing loss which will depend on the size of the hole in eardrum may be most common symptom. Other symptoms:

- Earache or discomfort
- A discharge of mucus from your ear
- Ringing or buzzing in your ear (tinnitus)

Perforated Eardrum - Treatment

In the video below, the eardrum surgery (myringoplasty) is animation. Dead cells are removed from the edges of the hole. Cartilage graft is placed on the hole. After placing sponges operation is terminated.

You can see detailed information about "Causes, Symptoms, Diagnosis and Treatment of Ear Drum Hole" at >> Causes, Symptoms, Diagnosis and Treatment of Ear Drum Hole / Ear Drum Repair (Tympanoplasty / Myringoplasty) in Istanbul

Tympanoplasty and myringoplasty have been described for surgical closure of the eardrum (tympanic membrane or Myrinx). In myringoplasty surgery, only the hole in the eardrum is performed; In tympanoplasty surgery, procedures are also performed for middle ear ossicles.

Types of tympanoplasty procedures 

5 types of tympanoplasty procedures have been described:

Type I tympanoplasty is also called “myringoplasty" ve and includes only perforated tympanic membrane restoration.

Type II tympanoplasty is used for erosion of the malleus and the eardrum. This involves placing grafts on the incus or malleus remnants.

Type III tympanoplasty is indicated in patients with intact and mobile stapes and two other ossicles (malleus-hammer bone and incus-anvil bone) that have been dissolved by inflammation. In this technique, grafts are placed on the stapes.

Type IV tympanoplasty is performed in patients with complete or partial melting of the stapes belt. It is defined as the placement of grafts on the base of mobile stapes.

Type V tympanoplasty is performed in patients with stapes base immobilized.

Endoscopic Eardrum Hole Surgery

Microscopic ​​Transcanal ​​Myringoplasty Video

Perforated Eardrum Repairing Surgery (Endoscopic ​​Transcanal ​​Myringoplasty)

Risks of Eardrum Surgery

Risks due to tympanic membrane surgery:

- Damage to the middle ear ossicles and related hearing loss
- Temporary or permanent reduction in taste on one side of the tongue
- Dizziness (vertigo)
- Infection
- Rarely bleeding

The Following Symptoms Are Normal After Eardrum Surgery

In eardrum surgeries, the closure of the membrane in the membrane is completed and spongosan and similar materials are placed on the membrane that stop the bleeding and fix the graft. These materials generally melt liquefied. For this reason, it is normal for the patient to have a small amount of sounds in the operative ear during eating after surgery. It is normal for these materials to mix with the blood and leave the external auditory canal, with a small amount of leakage.

Ear discharge usually decreases within days.

Hearing may be impaired during this post-operative period since a tampon is placed in the external auditory canal and usually remains between 1-3 weeks.

During tympanic surgery, the chorda tympani nerve (often temporarily) may be damaged, which allows the detection of the unilateral taste sense of the 2/3 anterior part of the tongue. Reduction in taste may occur on one side of the tongue after surgery.

When the eardrum surgery is performed by incision (incision) behind the auricle, post-operative dressing from the forehead to the ear can be made and this dressing usually remains for 1 day.

If an incision was made behind the auricle; numbness in this area is normal. This numbness will decrease in a few months.

During tympanoplasty operations, ossicular surgery or mastoidectomy can be performed along with the tympanic membrane. In this case, dizziness may occur in the first few days after surgery.

After hearing the tympanic membrane, it is necessary to wait at least 6 months before the hearing can be interpreted. The reason for this is that the swollen mucosa in the middle ear should return to normal, the blood will be sucked, and the inserted membrane should pass for at least 6 months to fully merge with the normal membrane.

Postoperative Patient Care For Eardrum Surgery

- In the first week after the operation, the head is raised and sleep decreases blood pressure and edema behind the ear and middle ear cavity. After the first week, the head can be brought back to normal.

- All exercise movements and daily activities that may cause air to be pushed into the middle ear cavity should be avoided.

- The mouth should not be closed during sneezing.

- Avoid lifting heavy objects for at least 2 weeks.

- To prevent constipation in the early postoperative period, it is more appropriate to feed on soft, warm and fibrous foods.

- Excessive cough can also be harmful, so medications can be used in this case

- The operated ear should be protected from water contact for the first 2 months. For this, cotton pads prepared by impregnation of petroleum jelly or ready ear plugs can be used after the ear pads are taken by the doctor. Low temperature hair dryer can be kept in the ear after surgery.

- Swimming, diving and water skiing are inconvenient for two months after surgery (I usually advise my patients to avoid swimming and water sports for at least 6 months).

- Tampers in the outer ear canal will be replaced by your doctor. These pads should not be removed without consulting your doctor.

- Strenuous athletic activities in the gym for one month after surgery should be avoided.

Eardrum Rapiring Failure

Eardrum Rapiring Failure - Tympanoplasty - Myringoplasty Failure
In the photo above, there is an image of the eardrum of a patient who underwent tympanoplasty to close the hole in the eardrum in another clinic. A slit-like perforation is seen in the cartilage graft just in front of the patient's eardrum. It can be seen that almost no part of the eardrum remains in this area and there is an occasional piece of the membrane in the form of a very thin band.
Endoscopic revision myringoplasty operation was planned for this patient.

After tympanoplasty or myringoplasty, it may not be possible to close the eardrum perforations almost completely. The reasons for this can be listed as follows:

- If the hole in the eardrum is too large, insufficient contact of the membrane edges with the placed graft (usually a small perforated area may remain at the anterior border, as in the photo above). Appropriate surgical technique and providing adequate visual angle can reduce this possibility. Especially in patients with curved anterior wall of the external auditory canal and the anterior part of the tympanic membrane cannot be seen clearly with the microscope, increasing the angle of view by turning this part of the external auditory canal with the help of a drill or using an endoscopic system at the same time may facilitate a clearer visualization of this area and surgical intervention.

- Problems with surgical technique or graft placement (excision of the dead epithelial area in the eardrum and contact of the graft with this area, that is, all edges of the perforation, is very important. The placement of the graft and deepitelization of the perforation edges, the choice of surgical technique are very important)

- Various factors related to the patient such as having a flu upper respiratory tract infection, sneezing, pressure increase, water leakage in the ear immediately after the eardrum surgery

- In case of chronic infection areas such as cholesteatoma in the middle ear or mastoid cells, performing tympanic membrane operation alone may cause increased infection and perforation of the membrane. Appropriate patient selection is very important. In dry and uninfected ears, only eardrum surgery can be planned; In patients with cholesteatoma and chronic suppurative otitis media, additional operations such as mastoidectomy may be required to clear the chronic infection.

The Price of Closure Surgery for Perforation of the Eardrum in Istanbul

The cost of closure of the eardrum holes varies between 3000 - 3500 US Dollars, depending on the hospitals and the operation time in Istanbul. The average price in luxury hospitals can go up to 4500 USD. Especially in large eardrum holes, patients with ossicular chain damage, eardrum operations can be performed by removing the eardrum or processing the ossicular chain, in addition to mastoidectomy operation can be performed in patients with chronic middle ear infections, in such cases the total operation fee may increase. Again, in suitable patients, this operation can be performed without making a visible incision in the external ear canal or outside the ear, using the endoscopic technique.

Link group where you can read articles about eardrum published on this website >> (You can browse other articles by clicking the more posts link at the end of the page.)

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

Private Office:
Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
Appointment Phone: +90 212 561 00 52
Mobile phone: +90 533 6550199
Fax: +90 212 542 74 47



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