复旦大学：《耳鼻咽喉科学》课程教学资源（PPT课件讲稿，英文版）Perforation of tympanic membrane

Perforation of tympanic membrane Chunfu dai Otolaryngology Department Pars flaccida Eye Ear Nose Throat Hospitall Anterior mallear Fudan University Pars tensa Manubrium I tympanIc ed through speculum

Perforation of tympanic membrane Chunfu Dai Otolaryngology Department Eye Ear Nose & Throat Hospital Fudan University

wor naber sd Pathogensis Direct force Careless while removal Malleus Incus Stapes wax by himself or herself Skull fracture may tear TM Hot slag fly into the ear Tympanic Round Base of stapes membrane window in oval window

Pathogensis ◼ Direct force ◼ Careless while removal wax by himself or herself ◼ Skull fracture may tear TM ◼ Hot slag fly into the ear

for deat sdl g latrelL Pathogenesis Right tympanis membr ane eardrum) ed through speculum Indirect force Increase in violence and firearms Associated with more dismal outcome More likely to involve intracranial lesions Malleus Incus Stapes Barotrauma Rapid pressure fluctuations with the Inner ear Air travel or SCUBA diving the bends> ympanic Round Base of stapes membrane window in oval window

Pathogenesis ◼ Indirect force ◼ Increase in violence and firearms ◼ Associated with more dismal outcome ◼ More likely to involve intracranial lesions ◼ Barotrauma ◼ Rapid pressure fluctuations with the inner ear ◼ Air travel or SCUBA diving ◼ “the bends

Associated complications Is usually associated with Malleus Incus Stapes TM or inner ear trauma unless latrogenic Ossicular discontinuity Facial Nerve Injury Chorda tympani Nerve InJury Barotrauma to Stapes footplate Tympanic Round Base of stapes membrane window in oval window

Associated complications Is usually associated with TM or inner ear trauma unless Iatrogenic ◼ Ossicular discontinuity ◼ Facial Nerve Injury ◼ Chorda tympani Nerve Injury ◼ Barotrauma to Stapes footplate

Clinic presentations otalgia Bleeding Fullness Hearing loss, conductive HL or mixed HL Tinnitus Shape of perforation is split

Clinic presentations ◼ Otalgia ◼ Bleeding ◼ Fullness ◼ Hearing loss: conductive HL or mixed HL ◼ Tinnitus ◼ Shape of perforation is split

Physical examination Tympanic perforation Central perforation Marginal perforation Blood crust If skull base fracture is occurred with csf leakage, clear fluid is observed

Physical examination ◼ Tympanic perforation ◼ Central perforation ◼ Marginal perforation ◼ Blood crust ◼ If skull base fracture is occurred with CSF leakage, clear fluid is observed

Diagnosis The key point is to exclude whether it associates with trauma to ossicular chain or to inner ear The audiometry can provide useful informations CHL 40db suspicion for ossicular discontinuity Hearing test reveals sensorneurous HL, it means Inner ear InJur

Diagnosis ◼ The key point is to exclude whether it associates with trauma to ossicular chain or to inner ear. ◼ The audiometry can provide useful informations. ◼ CHL > 40db suspicion for ossicular discontinuity ◼ Hearing test reveals sensorneurous HL, it means inner ear injury

Managements Antibiotic to prevent infection Aseptic external auditory canal with alcohol Prevent super respiratory infection Prohibit nasal blow Prohibit ear drops Long crus of incus Posterior mallear fold It takes 3-4 w to heal the ear drum Pars tensa If 3 months later, perforation still anubis Umbo exists, myringoplasty is indicated Cone of light Right tympanic membrane (eardrum)

Managements ◼ Antibiotic to prevent infection ◼ Aseptic external auditory canal with alcohol ◼ Prevent super respiratory infection ◼ Prohibit nasal blow ◼ Prohibit ear drops ◼ It takes 3-4 w to heal the ear drum ◼ If 3 months later, perforation still exists, myringoplasty is indicated

Preventions Be caution while removing your Wax Using ear plug Long crus of incus Posterior mallear fold Anterior mallear f Cone of light Righ viewed through speculum

Preventions ◼ Be caution while removing your wax ◼ Using ear plug