Reasons
The most common cause is acute purulent otitis media: pus accumulates in the tympanic cavity, puts pressure on the membrane, and it ruptures. Paradoxically, at this moment the person feels better: severe pain decreases because the pressure drops. The second large group is injuries: an attempt to clean the ear with a cotton swab, a match or a hairpin, a blow to the ear with an open palm, a fall on the water, a blast wave. Separately, barotrauma occurs when diving and flying with a stuffy nose. Less commonly, perforation occurs during chronic inflammation of the middle ear and lasts for years.
- Acute purulent otitis media
- Cleaning ears with chopsticks and foreign objects
- A blow to the ear, a fall on the water
- Barotrauma during diving and flying
- Blast and acoustic trauma
- Chronic otitis media
- Complication of medical procedures
Symptoms
With otitis media, perforation is manifested by sudden relief of pain and the appearance of discharge from the ear: at first it may be bloody, then it becomes purulent. In case of injury, on the contrary, sharp pain occurs, sometimes with bloody discharge. Hearing almost always decreases on the affected side and noise appears in the ear. A characteristic symptom is the feeling that when you blow your nose, air comes out through the ear. If the inner ear is damaged, severe dizziness and vomiting occur - this requires immediate medical attention.
- Sudden decrease in pain and appearance of discharge during otitis media
- Sharp pain and blood from the ear due to injury
- Hearing loss and tinnitus
- Sensation of air escaping through the ear when blowing the nose
- Congestion and clicking
- Dizziness due to damage to the inner ear
Diagnostics
An ENT doctor examines the ear using an otoscope or microscope: he sees the hole itself, assesses its size, location and condition of the edges, as well as the nature of the discharge. Hearing testing shows the degree and type of decrease, and tympanometry helps confirm the presence of communication between the outer and middle ear. In case of trauma with dizziness, persistent hearing loss, suspected damage to the auditory ossicles or a chronic process, computed tomography of the temporal bones is prescribed. In case of suppuration, a culture of the discharge is taken to select therapy.
- Ear examination with magnification
- Estimating hole size and location
- Hearing test
- Tympanometry
- CT scan of the temporal bones according to indications
- Sowing of discharge during suppuration
Treatment and care
Small traumatic perforations often close on their own within a few weeks, and the main goal during this period is not to interfere with healing. You need to keep your ear dry: do not swim with your head submerged, cover your ear when showering, do not go to the pool. You cannot instill drops, rinse the ear and blow it out without a doctor’s prescription, because drugs enter the middle ear through the hole and can cause harm. For purulent otitis media, treatment is prescribed by a doctor, including antibiotics if indicated. If the perforation has not closed after several months, discharge persists, or hearing is noticeably reduced, tympanoplasty is performed - an operation to restore the membrane.
- Keep your ear dry, cover it when washing
- Do not swim head-first or dive
- Do not clean your ear with chopsticks or rinse it yourself.
- Drops - only as prescribed by a doctor
- Gently blow your nose without force, using each nostril in turn.
- Treatment of otitis as prescribed by a doctor
- Control examinations before healing
- Tympanoplasty for persistent perforation
Prevention
Most perforations are preventable. The ears do not need to be cleaned with cotton swabs: the wax is removed on its own, but the stick pushes it deeper and can damage the membrane. When you have a runny nose, it is important to blow your nose correctly and treat nasal congestion in a timely manner, because it is the disruption of ventilation of the middle ear through the auditory tube that leads to otitis media. Before flying or diving, you should not fly with severe nasal congestion; Frequent swallowing movements and yawning during takeoff and landing help. It is important for children to promptly treat adenoids and recurrent otitis.
- Do not use cotton swabs to clean your ears
- Blow your nose correctly and gently
- Treat runny nose and nasal congestion
- Do not fly or dive with a stuffy nose
- Swallowing movements during pressure changes
- Timely treatment of otitis and adenoids in children
- Protect your ears from loud noise and shock
