eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Middle Ear & Mastoid

Middle Ear, Tympanic Membrane, Perforations: Workup

Author: Matthew L Howard, MD, JD, Head and Neck Surgery (Retired), Kaiser Permanente Medical Center, Santa Rosa, California
Contributor Information and Disclosures

Updated: Sep 25, 2009

Workup

Imaging Studies

Radiography and MRI are of no value unless the clinical picture suggests ossicular destruction and/or cholesteatoma. Asymptomatic perforations, especially if hearing is near normal, require no imaging studies.

Other Tests

  • Most tympanic membrane perforations (TMPs) are diagnosed using routine otoscopy.
  • Small perforations may require otomicroscopy for identification.
  • Some hearing screening programs include middle ear impedance testing.
  • Screening tympanometry may reveal abnormalities consistent with perforation. Confirmation still requires examination.
  • Always perform audiometry upon initial TMP diagnosis and again before any repair attempt, whether in the office or in the operating room.
    • Preoperative and postoperative audiography should always be performed. A major conductive loss not only alerts the surgeon to the possible existence of ossicular lesions, but documentation of a preexisting sensorineural hearing loss may protect the surgeon from later allegations that the surgery caused the hearing loss.
    • Audiometry often reveals normal hearing. The presence of mild conductive hearing loss is consistent with perforation, and a conductive component of at least 30 dB indicates possible ossicular discontinuity or a pathologic condition.

Diagnostic Procedures

In rare cases, otomicroscopy and impedance studies still leave the tympanic membrane perforation (TMP) diagnosis questionable. To provide evidence of perforation (in the form of a stream of bubbles), fill the ear canal with sufficient distilled water or sterile saline to cover the tympanic membrane and have the patient perform the Valsalva maneuver. A negative test result is suggestive but not definitive. A positive test result is caused only by tympanic membrane perforation (TMP).

Histologic Findings

In chronic tympanic membrane perforation (TMP), squamous epithelium is found adjacent to middle ear mucosa and creates a perforation edge with no raw surface. Such healing of the perforation edge is undoubtedly a contributing factor to perforation persistence.

More on Middle Ear, Tympanic Membrane, Perforations

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Multimedia: Middle Ear, Tympanic Membrane, Perforations
References
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References

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Further Reading

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Keywords

middle ear perforations, tympanic membrane perforations, tympanic membrane perforation, middle ear, eardrum, ear, perforated eardrum, middle ear perforation, eardrum perforation, tympanic membrane, perforated eardrum, eardrum, ear drum, tympanic membrane perforations, TMP, eardrum perforation, drum perforation, tympanoplasty, ear infection, ear perforation, middle ear infection, myringotomy, otoscopy, otomicroscopy

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Contributor Information and Disclosures

Author

Matthew L Howard, MD, JD, Head and Neck Surgery (Retired), Kaiser Permanente Medical Center, Santa Rosa, California
Matthew L Howard, MD, JD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Legal Medicine, and American College of Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Carol A Bauer, MD, FACS, Associate Professor of Surgery, Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine
Carol A Bauer, MD, FACS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Neurological Association, and Society of University Otolaryngologists-Head and Neck Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, 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, Department of Otolaryngology-Head and Neck Surgery, 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 unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
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