Perforated Ear Drum / Tympanic Membrane Perforation
A hole in the ear drum is called a perforated ear drum. The perforation can happen for a number of reasons, for example
-following Acute Otitis Media where the ear drum ruptures
-following grommet extrusion
-after ear drum trauma
How is a perforated ear drum treated?
Most perforated ear drums heal within a few weeks. Therefore, the management in the first instance is simple observation. Whilst the ear drum is perforated, it is best to avoid allowing water into the ears. If water gets in, the ear may be sore and could become infected. If infected, the ear will be leaking outwards; the treatment for this would be antibiotics, usually antibiotic ear drops.
If a perforation doesn't heal, it may cause little or no problems! Although a perforated ear drum can affect hearing, any hearing loss is often mild. If you have a long-term perforated ear drum that discharges now and then, this is called Chronic Suppurative Otitis Media. This means that the perforation is long-standing (chronic), discharges pus (suppurative), and with middle ear inflammation (otitis media).
If the ear drum doesn't heal by itself and cause problems, your child may benefit from surgery to have it repaired. This is called myringoplasty or tympanoplasty; both terms are used interchangeably and mean more or less the same thing. Surgery is done under general anaesthetic with the child asleep. There is a surgical scar either at the front or at the back of the ear. The surgeon will take some tissue from around the ear area and use that tissue to repair the ear drum. After surgery, a dressing my be placed in the ear; the dressing can be dissolvable, or it may need to be removed in clinic. Usually your child will also be given antibiotic ear drops at some stage following surgery.
What are the risks of ear drum repair?
Usually everything goes well. The main thing to be concerned about is the fact that the repair may not work. Your surgeon will be able to discuss this with you. In fact, we know that surgery is more effective in older children, so don't be surprised if your surgeon advises waiting until 8 years of age or older.
As with any operation, bleeding or infection can occur. Sometimes children's hearing can be worse, or they can develop dizziness, or ringing noises in the ear (tinnitus). The nerve that allows the face to move goes through the middle ear, so very rarely children could develop facial palsy, a weak droopy face. The nerve that allows you to taste also goes through the middle ear, so sometimes how things taste can be affected following surgery.
Vast majority of time everything goes well! Any surgery comes with possible side effects, so it is important that you are very sure that surgery is the right thing for you and your child before you proceed.
How to I keep the ears dry?
If your child has a perforated ear drum you may be advised to keep the ear dry. There are a variety of ways of doing this. You can buy ear plugs on the high street, or get custom ones made by audiology departments or hearing aid clinics. Cotton wool placed into the hollow of the ear (not poked into the ear canal!) and covered with vaseline on the outside also works. Swimming and shower caps or head-bands also work. A key thing when choosing what you do is to pick something that is not only effective, but your child will also tolerate.
Remember there is no need to use cotton buds! If your child has a discharging ear, you can mop up the discharge with dry tissue or gauze, but don't stick cotton buds into the ear canal.