Curriculum · ENT, Ophthalmology, and Dermatology
Tympanic membrane perforation
Causes and risk
Three routes recur. Acute otitis media may perforate the drum, and the perforation is commonly associated with relief of symptoms and discharge. Cleaning the ears out with cotton buds does it. Barotrauma does it too, as after a first dive. It is also an important differential where the patient's job is that of a professional boxer.
How it presents
In the otitis media route there is a few days of fever and irritability with rubbing of one ear, then the pain stops dramatically and is followed by oozing discharge from that ear; otoscopy then shows a perforated tympanic membrane on that side while the other ear looks normal. After cleaning the ears with cotton buds there is pain in that ear from that day on, and the hearing feels affected. After barotrauma there is hearing loss and mild pain inside the ear with no discharge, and otoscopy shows a perforated tympanic membrane with slight erythema and no effusion. A perforation gives conductive hearing loss, so Rinne's and Weber's tests showing sensorineural loss argue against it.