Common causes of tympanic membrane perforation include chronic suppurative otitis media, foreign bodies in the ear canal, blast injuries, trauma, pneumatic (water pressure) injuries, thermal injuries and chemical burns. Eardrum perforation can lead to hearing loss and recurrent middle ear infections and pus. The eardrum has the function of collecting sound and amplifying sound, so perforation reduces the effective vibration area of the eardrum and reduces the energy of external sound waves into the inner ear, so eardrum perforation can lead to hearing loss. In addition, the tympanic membrane is the gateway between the outer ear and the middle ear and acts as a barrier to protect the middle ear cavity.
I. Tympanic membrane repair is a kind of otologic microsurgery, and the main purposes of the surgery are
1. To close the perforation and prevent the chance of foreign infection so that the flow of pus and pain can be controlled.
2. to improve the quality of life, such as normal swimming, bathing and hair washing
2.To improve hearing.
2.Who needs tympanic membrane repair? When is tympanic membrane repair suitable?
Those who have perforated tympanic membrane for a long time due to various reasons, those who have large perforations and those who have marginal perforations that cannot heal on their own, or those who have been treated ineffectively with antibiotics or other non-surgical therapies, have to consider tympanic membrane repair. However, the survival rate of tympanic membrane repair is lower in the elderly due to poor blood flow to the graft and middle ear localization, and it is often accompanied by neurological deafness and limited hearing improvement, so the upper age limit for tympanic membrane repair is generally 60 years old, with good general condition and Children under 12 years of age with tympanic membrane perforation should not be operated because of the anatomical characteristics of the eustachian tube and the difficulty of changing medication and caring for children after surgery.
Not all patients can undergo tympanic membrane repair immediately after tympanic membrane perforation is detected.
1. chronic suppurative otitis media requiring dry ears for more than 1 month (including those with a slightly moist surface of the tympanic mucosa due to small occult lesions or allergic reactions)
2. traumatic tympanic membrane perforation, more than 90% of the central type perforations in the tension section can heal spontaneously, but those that fail to heal spontaneously for more than 3 months require surgical repair of the tympanic membrane
3. no inflammatory lesions of the skin of the external auditory canal; blockage of the eustachian tube (excluding membranous blockage of the eustachian tube bullae), which will be complicated by plagioid otitis media if tympanic membrane repair is performed
4. acute upper respiratory tract infections and infectious diseases must be controlled during the acute phase before surgery can be considered.
5. cannot have serious systemic diseases that cannot tolerate surgery, such as uncontrolled hypertension, diabetes mellitus and impaired coagulation mechanisms
6. If there is limited epithelialization and cholesteatoma in the tympanic chamber mucosa, it must be removed before the tympanic membrane can be repaired, otherwise it will be complicated by middle ear cholesteatoma.
III. Success rate of surgery? Is the surgery risky?
The surgeon’s surgical technique, dry ear time (time without pus), the presence of occult lesions, the presence of allergic reactions, and the patency of the eustachian tube, etc. currently have a reported success rate of 90-95% in China. Tympanic membrane repair surgery is a relatively safe surgery. There are more types of possible complications of the surgery, but the incidence is low and most of them are mild.
Fourth, post-surgery precautions.
1. Pay attention to rest, control blood sugar, blood lipids and blood pressure, and quit smoking and drinking.
2. Avoid exposure to strong noise and use of ototoxic drugs.
3. Do not expose the ear and incision to water to prevent infection.
4.Prevent upper respiratory tract infection (cold); do not blow your nose forcefully; do not fly for three months.
5. Avoid strenuous exercise for 3 months after the placement of the artificial hearing bone.
6.Use medication as prescribed by the doctor, review regularly, remove stitches and external ear canal gauze as required by the doctor, remove stitches 7 days after surgery, remove external ear canal gauze 10 days after surgery.
7. Review hearing regularly.