”How is it possible that the eardrum is perforated? I just slapped him, doctor, you have to look at it!” A cacophony of indignation came from the ENT consultation room.
Recap of the incident.
Chen Hao and Wu Lianlian are classmates, today at school because of the duty sweeping problem argued and fought, the result of Xiao Wu “won the battle”. After school, Chen’s father went to school to pick up his son when he learned of the incident, and felt that his child was bullied, so he raised his hand and “rewarded” Xiao Wu a slap. This “reward” made Xiao Wu feel pain in his ear, and when he got home, he told his mother what had happened, which led to the scene at the beginning of this article. Dr. Xiong Guanxia of the Department of Otolaryngology at the First Hospital of Sun Yat-sen University concluded that Xiao Wu had a traumatic tympanic membrane perforation after examination, but Xiao Chen’s father expressed doubts about the diagnosis.
”After Xiao Chen’s dad slapped me, it felt like my ear hurt all the time, and it was like a mosquito was chirping inside my ear.” Xiao Wu said.
”Oh, that’s called tinnitus.” The doctor asked Wu again, “Do you hear things clearly?”
”It’s a little worse than before, but I can still hear.” Wu replied.
The doctor examined Wu’s ear with an electric otoscope and found a crack in the lower front of the eardrum with a blood crust attached around it. Based on Xiao Wu’s history of being beaten and having ear pain, tinnitus and hearing loss, as well as the fresh perforation and blood found in the eardrum on examination, a diagnosis of tympanic membrane trauma could be made. However, in order for Xiao Chen’s father to see objective evidence, Xiao Wu also had to have an otoscopy and a photograph taken; in addition, Xiao Wu’s hearing condition had to be checked.
Hearing this, Xiao Chen’s father’s anger subsided and he awkwardly asked, “Isn’t the eardrum inside the ear? Why did it break so easily? Is slapping so serious?”
The doctor commented: Although the eardrum is at the innermost part of the external ear canal, it is very thin and consists of only epithelial and fibrous tissues; while the other four walls of the external ear canal are bony structures that are quite strong. When the air pressure changes dramatically, such as explosions, cannon shock and palm strikes to the ear, the tympanic membrane becomes vulnerable to this air pressure trauma.
Tests have found that the tympanic membrane can be ruptured when it is subjected to a pressure of 2.25 kg/cm2; and at a pressure of 6.75 kg/cm2, the tympanic membrane can be perforated in 50% of adults.
Xiao Chen’s father as an adult male, a slap is certainly not small, the eardrum can not be perforated?
Doubt 1: Will a broken eardrum lead to microbial infection in the ear and skull soon after?
Solution: If the tympanic membrane is properly treated after trauma, it will not usually cause infection. If infection does occur, systemic anti-infective treatment should be intensified, and the ear canal should be cleaned locally and antibiotic drops should be applied, which is the same as for acute suppurative otitis media.
Doubt 2: Do I need to repair the eardrum immediately?
If there is no secondary infection after the tympanic membrane is broken, most small perforations can heal on their own and we usually observe them for 1~2 months.
Doubt 3: Will my hearing be affected after the repair?
Solution: Don’t worry too much. If it is a simple tympanic membrane perforation, hearing can generally be restored after healing. However, in some cases, if there is a combination of damage to the auditory chain and the inner ear, it is more problematic and there is a chance that hearing will not be restored and long-term tinnitus will remain.
Doubt 4: Is tympanic membrane repair surgery a big operation? Will there be other after-effects?
Answer: Tympanic membrane repair is a relatively mature otologic surgery, and there is now minimally invasive endoscopic tympanic membrane repair surgery, which is more effective. Of course, any surgery has its own risks, and individual cases vary, so it is not possible to generalize.
Doubt 5: Can I not do any sports during the recovery period?
Answer: The key after tympanic membrane trauma is to keep the ear canal dry and clean. Until the eardrum has healed, water sports activities are absolutely not allowed, but general sports are still possible.
Trivia: Treatment after an eardrum break.
①You should go to the hospital, disinfect the external ear canal with ethanol and then remove the cerumen and foreign bodies in the external ear canal; while uninfected blood clots attached to the eardrum can be left out.
②No rinsing or drops of medication are allowed in the external ear canal. When washing hair or bathing, pay attention to the ear canal not to enter water, and keep the ear canal dry to avoid secondary infection of the middle ear.
③Apply antibiotics to the whole body for a short period of time to prevent infection. If the injured environment is not clean, tetanus antitoxin must be used.