Middle Ear, Tympanic Membrane, Infections Treatment & Management

  • Author: John Schweinfurth, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Mar 12, 2012
 

Medical Care

  • Seek emergency department or primary care when a patient presents with acute myringitis, suspected otitis media, external otitis, or foreign bodies in the ear.
  • Analgesics, anti-inflammatory medications, antipruritics, and antihistamines may be prescribed.
  • In case of suppurative complications, perforated TM, or suspicion of mastoiditis, consultation with an otolaryngology (ENT) specialist is imperative.
  • The advice of the skilled ENT specialist is required to choose appropriate medication and to ensure successful treatment of chronic myringitis accompanied by perforation of the TM.
  • Specific treatment of TM perforation includes the following:
    • Solutions of alcohol containing salicylic acid stimulate growth of the epithelium, which is very useful if the growth rate of the epithelium is diminished. However, when in contact with the mucosae of the middle ear, alcohol can cause earache and excessive irritation of the mucosae with subsequent increased secretion of mucus.
    • Aqueous solutions may help to eliminate inflammation of the mucosae in the middle ear, but they cause maceration of the epidermis in the auditory canal. In addition, granulation tissue or polyps must be removed.
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Surgical Care

Untreated chronic perforation may result in exacerbation of COM and myringitis. Closure of perforations is also indicated in patients who enjoy water activities. Surgical closure of the TM perforation is called myringoplasty. Today, myringoplasty has made such viable progress that, in 70-90% of cases, a new TM is actually formed.

Methods of partial surgical closure of TM perforations have been proposed. They consist of removing the epithelium from the edges of the perforation, covering it with film or paper on which the epidermis and the mucosa continue to grow, and, occasionally, blocking the perforation. However, such film is very thin and can be destroyed merely by sneezing. This procedure is typically reserved for perforations of less than 10%.

A useful method of myringoplasty, described by Heermann, uses a cartilaginous framework. The TM is supported by the cartilaginous palisade without affecting mobility. Other techniques have used temporalis fascia and loose areolar tissue as graft material.

  • Preoperative details: The basic condition for preparation of the TM for myringoplasty is absence of moisture and infection.
  • Intraoperative details: Intraoperative details are related to the anatomic features of the ear canal, the range of abnormalities to the middle ear, and the method of myringoplasty chosen by the surgeon.
  • Postoperative details: The ear should be kept dry. The patient should avoid positions and activities that place undue pressure on the graft. An antibiotic-soaked packing is left in the external canal through days 7-14. Remove at follow-up visitation and begin administration of eardrops for 7-10 days.
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Activity

Many surgeons postpone swimming until the ear is completely healed, or up to 6 months. In addition, some surgeons recommend water precautions during bathing for several weeks.

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Contributor Information and Disclosures
Author

John Schweinfurth, MD  Professor, Department of Otolaryngology, University of Mississippi Medical Center

John Schweinfurth, MD is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Laryngological Association, American Medical Association, and Triological Society

Disclosure: Nothing to disclose.

Coauthor(s)

Yuri P Uliyanov, MD, PhD  Director, Department of Ear, Nose, and Throat, Agami Medical Center

Yuri P Uliyanov, MD, PhD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael E Hoffer, MD  Director, Spatial Orientation Center, Department of Otolaryngology, Naval Medical Center of San Diego

Michael E Hoffer, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery

Disclosure: American biloogical group Royalty Other

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Gerard J Gianoli, MD  Clinical Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine; Vice President, The Ear and Balance Institute; Chief Executive Officer, Ponchartrain Surgery Center

Gerard J Gianoli, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Neurotology Society, American Otological Society, Society of University Otolaryngologists-Head and Neck Surgeons, and Triological Society

Disclosure: Vesticon, Inc. None Board membership

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Medvoy Ownership interest Management position; Cerescan Imaging Consulting; Headwatersmb Consulting fee Consulting; Venturequest Royalty Consulting

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Tympanic membrane (TM) as continuation of the upper wall of external auditory canal (EAC) with angle of incline up to 45 degrees on the border between middle ear and the EAC.
Normal tympanic membrane. Pars tensa (PT), pars flaccida (PF), light reflex (LR), fibrous ring (FR), umbo (Um), handle of malleus (HM), lateral process of malleus (Lpm), anterior plica (AP), posterior plica (PP).
Mirror display of a tympanic membrane surface on the polymeric masc from external acoustical canal of healthy man. Masc of tympanic membrane surface (MtmS).
 
 
 
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