tympanic membrane perforation
Introduction
Introduction to the tympanic membrane Tympanic membrane perforation is a kind of middle ear trauma caused by violence, traffic accidents, or changes in air pressure. The motherland medicine is a "ear leaking tube". Tympanic membrane perforation is often encountered in forensic clinical identification. There are many reasons for perforation of the tympanic membrane. It is mainly divided into traumatic (direct or indirect external force) tympanic membrane perforation and inflammatory tympanic membrane perforation. The former is such as blunt tools (including palm and fist). Etc.) Strike, skull base fracture, explosion, ear inadvertent, acupuncture, burns and even insects can be caused by the ear. The traumatic tympanic membrane perforation discussed here mainly refers to traumatic tympanic membrane perforation caused by indirect external force, inflammatory tympanic membrane. Perforation is mainly caused by acute otitis media and chronic otitis media. basic knowledge The proportion of illness: 0.002% Susceptible people: no special people Mode of infection: non-infectious Complications: otitis media
Cause
Tympanic membrane perforation
The tympanic membrane is located in the deepest part of the ear canal and has certain elasticity and toughness. It is not easy to be damaged or perforated under normal conditions, but it is easy to cause perforation under the following specific reasons.
1, direct trauma: more common in the head suffered from trauma, combined with tympanic membrane damage to the tympanic membrane. In addition, if you use too much force or collide with others, you will also wear the tympanic membrane. Secondly, splashed metal powder, slag, electric welding sparks and mis-dropping corrosive agents, such as strong acid and strong alkali, will corrode the tympanic membrane and cause perforation.
2, indirect trauma, common in the rapid changes in atmospheric pressure, such as the rapid decline of aircraft, shells, shooting, loud noise, air waves will break the tympanic membrane. Usually slap in the face can also damage the tympanic membrane and piercing. The air pressure in the middle ear cavity rises sharply, and the internal and external air pressure imbalance occurs. Such as forceful nose and other reasons.
3, Eustachian tube infection: more common in infants and young children, because the baby's eustachian tube is short and thick, the tube is also straight, nasal secretions, milk, etc. easy to flow through the eustachian tube or into the middle ear, acute otitis media . After the middle ear is purulent, the pus corrodes the tympanic membrane, causing perforation of the tym
Prevention
Tympanic membrane perforation prevention
1. Keep the external auditory canal clean and dry. After trauma, the external auditory canal can be disinfected with alcohol, and the foreign body and sputum of the external auditory canal can be wiped and removed. Do not remove the bloody sputum attached to the tympanic membrane. So as not to cause bacterial infection. Gently stuff the cotton into the outer ear canal with sterile cotton to prevent dirt from entering the ear and causing infection.
2. Do not rinse the external auditory canal with water, and do not use any medicine to drop the ear, because it is not only useless, but can cause bacteria to enter the middle ear to cause infection.
3. Do not force your nose. If you have a snot, you can spit it out. You can also take anti-inflammatory drugs to avoid infection. If an infection occurs, causing suppurative otitis media, it should be treated according to otitis media.
4. Carefully dig your ears and use the unclean utensils to dig your ears and bring bacteria into it.
5. Beware of colds, the onset of otitis media is usually caused by a cold.
6. Prevent inappropriate nose, such as pinching the two nostrils to force the nose, easy to squeeze the secretions of the nose through the eustachian tube to the middle ear, causing inflammation. Therefore, you should gently sneeze your nose on one side of your nose.
7. Strengthen hygiene and prohibit the use of unsanitary or hard things to rub your ears. So as not to hurt the ear or bacteria into the ear to cause infection.
Self care
1. Those who suffer from perforation of the tympanic membrane should always keep the ear dry and clean, waterproof into the ear, can not swim, wash the head and bath with a sterile cotton ball to plug the ear canal; carry the sterile cotton swab properly, every 2 hours, Please gently wipe yourself for yourself.
2. Be careful to stay away from the dusty space. In windy weather, plug your ears and go out.
3. Pay attention during the mending period, do not do strenuous exercise and heavy physical labor; especially the bending of the action should be prohibited, but also pay attention to not chew hard food.
4. Pay attention to prevent colds and colds, keep the nasal cavity unobstructed; prevent inappropriate nose, such as pinching the two nostrils to force the nose, easy to squeeze the secretions of the nose through the eustachian tube to the middle ear causing inflammation, should block one side of the nostrils Gently sneeze.
5. Patients should strengthen nutrition, eat more easily digestible foods, exercise properly, pay attention to rest, improve immunity; prevent constipation.
Complication
Tympanic membrane perforation complications Complications otitis media
After the perforation of the tympanic membrane, the protective effect is lost, and bacteria, sewage, and foreign matter from the outside can be perforated into the middle ear to cause infection and pus. The middle ear is connected to the outside world, swimming, shampooing or in a turbid environment, bacteria are easy to enter, causing otitis media. Repeated episodes of otitis media will increase the perforation of the tympanic membrane and harden the adhesion of the middle ear, which will further reduce the hearing. More serious is that it can also lead to osteoarthritis or cholesteatoma otitis media. When the bone is eroded, it may cause intracranial and extracranial complications such as facial nerve spasm, meningitis, brain abscess, and even life-threatening.
Perforation reduces hearing: the sound first vibrates the tympanic membrane, and then passes through the middle ear ossicular chain to the cochlea, which causes nerve reflex to form hearing. After the tympanic membrane is perforated, the effective vibration area of the tympanic membrane is reduced, and the energy of the external acoustic wave is transmitted to the inner ear, and the hearing loss is reduced. .
Symptom
Tympanic membrane perforation symptoms common symptoms ear canal bleeding tinnitus earache ear canal scratch squamous epithelium deafness point hemorrhagic neurological deafness
The clinical manifestation of tympanic membrane perforation is that the hearing is from normal to moderate deafness, consciously blocked, and even earache. After several hours, due to exudate, the symptoms of earache are relieved, often accompanied by tinnitus. At the beginning, only the tympanic membrane was completely congested. With the tympanic membrane invagination, spotted hemorrhage occurred, causing sensorineural deafness. Explosive tympanic membrane perforation, due to squamous epithelial varus into the tympanic cavity to form squamous epithelial cysts, easy secondary infection.
1. Hearing from normal to moderate deafness, consciously have a sense of obstruction, and even earache.
2. After a few hours, the symptoms of earache are alleviated due to the exudate.
3. There are signs of tinnitus.
4. At the beginning, only the tympanic membrane was completely congested. With the tympanic membrane invagination, spotted hemorrhage occurred, causing sensorineural deafness.
5. Explosive tympanic membrane perforation, due to squamous epithelial varus into the tympanic cavity to form squamous epithelial cysts, easy to secondary infection.
Examine
Tympanic membrane perforation
1. Pure tone hearing threshold examination: pure tone hearing threshold is the basis for monitoring the progress of otological diseases, evaluating the curative effect, selecting prevention and treatment - rehabilitation measures, evaluation of disability, and forensic identification. The use of standard audiometers for hearing tests is a widely accepted and widely accepted method of examination that accurately reflects the sensitivity of hearing. Through this check, the patient's sensitivity to sound can be detected.
2, ear endoscopy: endoscope is an optical instrument, sent from outside the ear canal, examination of the eardrum tympanic membrane disease, you can directly observe the ear canal, tympanic membrane depression, perforation, etc., determine its location, The range, and can be photographed, biopsied or brushed, greatly improving the diagnostic accuracy of conductive deafness, and can check the corrosion of the hearing aid horn.
3. Check the function of the eustachian tube: The eustachian tube is a tube that communicates the tympanic cavity and the nasopharynx. Its function is closely related to the physiological function of the middle ear, which is of great significance for the prevention and treatment of middle ear disease. There are usually 3 ways:
1Pressing the nasal air (Valsalva) method: After the patient inhales, pinch the nostrils on both sides with your fingers, close the mouth, and forcefully exhale from the nose, so that the pharyngeal air can be flushed into the eustachian tube.
2 balloon stripping (Politzer) method: the patient's mouth contains water, the olive head with the eustachian tube blowing the ball is inserted into the pupil of one side of the patient, and the other nostril is pressed by the finger, and the sphere is pressed while the water is swallowed. Air can be flushed into the Eustachian tube.
3 catheter blowing method: the patient takes a seat, cleans the nasal secretions, and then inserts the eustachian tube elbow down the bottom of the nose, and reaches the posterior wall of the nasopharynx, then turns to the outside 90°, then pulls forward slightly. The catheter is slid over the bulge and slid into the mouth of the eustachian tube. The catheter is fixed, and the air is injected through the catheter with a blown ball. At the same time, the ear can be heard by the ear to check whether the eustachian tube is patency or not.
Diagnosis
Tympanic membrane perforation diagnosis
The diagnostic points for tympanic membrane perforation are:
(1) has a history of ear or head injuries;
(2) accompanied by earache, deafness, and a small amount of bleeding in the external auditory canal;
(3) The shape conforms to the characteristics of traumatic perforation: the perforation is mostly located in the tension part, which is fissure-like, triangular, irregular, etc., the perforation edge is sharp, everted, and bloody;
(4) The acoustic impedance test cannot lead to the tympanogram, or the injured ear is B-shaped but the external auditory canal volume is significantly larger than the healthy ear;
(5) Exclude perforation caused by otitis media. Acoustic impedance and ear endoscopy can objectively and truly reflect the morphological features of the tympanic membrane perforation, and can provide an objective basis for the forensic identification of traumatic tympanic membrane perforation.
