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Abstract: The patient was admitted to the hospital with a traumatic tympanic membrane perforation in the right ear for six months. Otoscopy, pure tone audiometry, eustachian tube function, and CT of the temporal bone were performed, and there was no stenosis in the external auditory canal and an indication for surgery, so an endoscopic exploration of the auditory chain and type I tympanoplasty were performed. During the operation, the auditory chain was found to be active, and the perforation of the tympanic membrane tension was repaired by taking cartilage from the ear screen. The postoperative recovery was smooth, and the tympanic membrane perforation was healed and the hearing was significantly improved compared with the preoperative period at a follow-up examination 4 weeks after discharge.
Basic information】Female, 39 years old
Type of disease】Traumatic tympanic membrane perforation
Hospital】Qilu Hospital of Shandong University
Date of Consultation】December 2021
Treatment plan】Surgical treatment (endoscopic auditory chain exploration, type I tympanoplasty, endoscopic-assisted microscopic internal tympanoplasty)
Treatment period】4 days of hospitalization and regular outpatient follow-up
Treatment effect】healing of tympanic membrane perforation, hearing improvement
I. Initial consultation
Six months ago, the patient suffered from a tympanic membrane perforation caused by the inflow of hot oil into the right ear, followed by hearing loss in the right ear with tinnitus, which was a persistent cicada sound, without symptoms such as water flowing in the ear, pus, headache and dizziness. The patient had been seen at a local hospital, but no special treatment was given. After six months of observation, the tympanic membrane perforation did not heal, so the patient became more anxious and was examined at our clinic.
The examination showed that the patient had a large perforation of the right tympanic membrane tension, and pure tone audiometry showed conductive deafness in the right ear with a bone and air conduction difference of about 30 dB. Combining the medical history, symptoms and examination results, a preliminary diagnosis of traumatic tympanic membrane perforation in the right ear was made, and the patient was admitted to the hospital.
II. Treatment history
After admission, otoscopic examination showed a large perforation of the right ear tension, and pharyngeal function test showed a score of 10 in the right ear. The patient had a non-healing tympanic membrane perforation, a dry ear, no neurological deafness, normal eustachian tube function, an indication for surgery, and no stenosis in the external ear canal. This procedure has the characteristics of no postauricular incision, aesthetics, minimal trauma and quick recovery, but the surgery may not improve the tinnitus, and the patient expressed his understanding and consent to the surgery. The endoscopic exploration of the auditory chain and type I tympanoplasty of the right ear were performed under general anesthesia, and the auditory chain was found to be active during the operation.
III. Treatment results
The patient had no postoperative discomfort such as ear pain, no aggravation of tinnitus, quick postoperative recovery, short hospitalization time, and was discharged within 4 days without delaying his daily work. Before discharge, the patient was instructed to conduct regular review. 4 weeks after the operation, the right tympanic membrane perforation was healed and the hearing was significantly improved compared with that before the operation. Three months after the operation, the hearing was optimal. The patient expressed satisfaction with the treatment result.
IV. Notes
We are glad that the patient was cured of the tympanic membrane perforation after treatment. After discharge, the patient should regularly clean the secretions at the external ear canal opening to keep the operated ear clean and dry. Pay attention to your diet, prohibit spicy and stimulating food, do not smoke or drink, and eat more vegetables and fruits. It is forbidden to pull out the ear in life, pay attention to the prevention of upper respiratory tract infection, avoid water in the external ear canal to prevent infection, and avoid forceful nose blowing and sneezing to prevent the fascia from shifting and the perforation from not healing. If discomfort such as pus flow and ear pain occurs, prompt medical consultation is required. Under normal circumstances, a review is required 4 weeks after surgery to clean the residual hemostatic sponge and scabs in the external ear canal and to check the healing of the eardrum and hearing.
V. Personal insight
Tympanic membrane perforation can cause hearing loss and recurrent otitis media, and trauma is one of the common causes. If the tympanic membrane perforation does not heal, surgery is usually recommended, and in this case, the patient underwent surgery. For most patients, endoscopic tympanic membrane repair is the preferred surgical procedure, where the cartilage or cartilage membrane of the ear screen is taken and the perforation is repaired by endoscopic assisted microscopic built-in tympanoplasty or endoscopic laminated tympanoplasty ear repair.