Perforated Eardrum & Tympanoplasty

A perforated eardrum means there is a hole in the eardrum, which may have been caused by infection or injury. Acute perforations (e.g. caused by an injury or infection) may heal themselves. Perforations that have been present for several weeks are unfortunately unlikely to heal spontaneously. It may be the cause of recurrent infections with a discharge from the ear. If you have an infection you should avoid getting water in the ear. Most perforations produce some degree of hearing loss.

Surgery to repair the perforation

An operation to repair the perforation is called a ‘tympanoplasty’. The benefits of closing a perforation include prevention of water entering the middle ear, which could cause ear infection. Repairing the hole means that you should get fewer ear infections. It may result in slightly improved hearing, but repairing the eardrum alone seldom leads to great improvement in hearing because we produce scar tissue in place of the hole, and this does not conduct sound very well.

The Tympanoplasty operation

The operation is almost always done under general anesthetic. A cut may be made behind the ear or above the ear opening. Occasionally, your surgeon may need to widen the ear canal with a drill to get to the perforation. The material used to patch the eardrum is taken from under the skin. Sometimes, artificial grafts may be used. This eardrum ‘graft’ is placed against under the eardrum. Dressings are placed in the ear canal. You may have an external dressing and a head bandage.

The operation can successfully close a small hole nine times out of ten. The success rate is not quite so good if the hole is large or there is active infection or in very young children.

Hearing Loss & Deafness

Hearing loss is common and can affect people of any age. It is thought that half the general population above the age of 75 have some hearing loss. Children are the next most common group to be affected, usually due to fluid or infection in the middle ear, but also due to congenital (hereditary) problems or viral illness during early childhood.

Types of deafness

The causes of deafness can be broadly grouped according to where in the ear they occur. A problem of transmission (or conduction) of soundwaves through the ear canal and middle ear is referred to as a “conductive” hearing loss. A problem with the translation of the sound waves into an electrical signal by the inner ear or the onward passage of those electrical impulses via the nerves to the brain is referred to as a “sensorineural” hearing loss.

There are a great number of causes of conductive hearing loss including blockage by wax, infection, a collection of fluid, trauma or fixation of the ossicles in the middle ear (which is called otosclerosis). Fortunately, they can often be treated and hearing in the infected ear can be corrected or improved.

A sensorineural hearing loss is due to a problem of the inner ear or of the nerve that carries the signal from the inner ear to the hearing centers in the brain. Again there are many causes, the most common being that of hearing loss in old age, (“presbyacusis”), which usually affects both ears to a similar degree and can be associated with noises in the ear (tinnitus). Other common conditions which affect the inner ear are infections (particularly by viruses), trauma, the side effects from certain medication and congenital causes. While some inner ear problems are reversible, generally speaking the hearing loss is irreversible (ie permanent). Extremely rarely, but more seriously, the hearing loss may be due to a growth, (ie. a tumor) affecting the hearing nerve in the brain. For this reason, it is important to seek a specialists’ advice if one ear is affected, rather than both.

Otitis Externa

This one of the commonest ear infections and is frequently associated with entry of water into the ear which can often trigger a flare-up. It is regrettably also prone to recurrence, particularly if the sufferer succumbs to scratching and poking inside the ear with cotton-tip buds, matches, finger-nails etc.

Otitis externa occurs mainly in adults and very frequently in those who swim a lot, although water is frequently not involved. It is caused by pseudomonas germs which can be difficult to eradicate. Symptoms include, pain, irritation, discharge deafness/muffled hearing and even some bleeding occasionally.

The key to rapid improvement is to clear away the debris and instill antibiotic ear drops. Repeated suction-clearance if often required. Whilst this is seldom painful, antibiotic drops themselves often cannot eradicate the infection alone. Syringing of ears when infected is painful and not recommended.

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