A hole in the ear drum (see above), or a ‘perforation’ is a common reason you or your child may have lots of ear infections.
Holes in ear drums are not uncommon and may occur as a result of an infection or an injury to the ear. When they do occur, however, they usually heal on their own within a few days or weeks. When they go on for longer than this, they may require treatment.
The two things perforations cause are hearing loss and infections. Hearing loss occurs because the hole in the ear drum means that it will not vibrate as much when a sound wave hits it. Infections occur for two reasons. Firstly, the open ear drum means that bacteria from the outer part of the ear can get into the warm and moist middle ear, where they then cause infection. This can be more likely when water gets in the ear, as it can wash bacteria through the hole. For this reason, it may be recommended to avoid letting water get in the ear - especially dirty water. We call this taking ‘water precautions’. Secondly, when you have a cold, and infection gets into the ear from the nose, the hole in the eardrum means that mucous-like discharge can come from the ear (1).
If the ear infections, water precautions, or hearing loss are causing a problem, then operations to close the ear drum can be performed.
Ideally, these operations are done without making any cuts on the skin outside the ear - by passing small instruments down the ear canal. In younger children (below the age of 8) with a narrow ear canal, a small cut may need to be made behind the ear. Dressings are placed in the ear afterwards which are removed between one and three weeks after the operation. The hearing goes up and down after these dressings are removed, and so we wait until between six and eight weeks after surgery to measure it again. The chance of completely closing the ear drum is about 85% (2), and in a similar proportion of cases the hearing will improve. The operation can be done at any age with similar success rates (3). There are small risks of a funny taste in the mouth for a few weeks after surgery, of the hearing going down, and of infection.
The operation is usually performed as a daycase procedure.
References:
1. Subversion of host immune responses by otopathogens during otitis media. Parrish JM, Soni M, Mittal R. J Leukoc Biol. 2019 Oct;106(4):943-956.
2. Type I Tympanoplasty Meta-Analysis: A Single Variable Analysis. Tan HE, Santa Maria PL, Eikelboom RH, Anandacoomaraswamy KS, Atlas MD. Otol Neurotol. 2016 Aug;37(7):838-46.
3. Tympanoplasty for Chronic Tympanic Membrane Perforation in Children: Systematic Review and Meta-analysis. Hardman J, Muzaffar J, Nankivell P, Coulson C. Otol Neurotol. 2015 Jun;36(5):796-804.
The image below shows a total perforation of the tympanic membrane:
Holes in ear drums are not uncommon and may occur as a result of an infection or an injury to the ear. When they do occur, however, they usually heal on their own within a few days or weeks. When they go on for longer than this, they may require treatment.
The two things perforations cause are hearing loss and infections. Hearing loss occurs because the hole in the ear drum means that it will not vibrate as much when a sound wave hits it. Infections occur for two reasons. Firstly, the open ear drum means that bacteria from the outer part of the ear can get into the warm and moist middle ear, where they then cause infection. This can be more likely when water gets in the ear, as it can wash bacteria through the hole. For this reason, it may be recommended to avoid letting water get in the ear - especially dirty water. We call this taking ‘water precautions’. Secondly, when you have a cold, and infection gets into the ear from the nose, the hole in the eardrum means that mucous-like discharge can come from the ear (1).
If the ear infections, water precautions, or hearing loss are causing a problem, then operations to close the ear drum can be performed.
Ideally, these operations are done without making any cuts on the skin outside the ear - by passing small instruments down the ear canal. In younger children (below the age of 8) with a narrow ear canal, a small cut may need to be made behind the ear. Dressings are placed in the ear afterwards which are removed between one and three weeks after the operation. The hearing goes up and down after these dressings are removed, and so we wait until between six and eight weeks after surgery to measure it again. The chance of completely closing the ear drum is about 85% (2), and in a similar proportion of cases the hearing will improve. The operation can be done at any age with similar success rates (3). There are small risks of a funny taste in the mouth for a few weeks after surgery, of the hearing going down, and of infection.
The operation is usually performed as a daycase procedure.
References:
1. Subversion of host immune responses by otopathogens during otitis media. Parrish JM, Soni M, Mittal R. J Leukoc Biol. 2019 Oct;106(4):943-956.
2. Type I Tympanoplasty Meta-Analysis: A Single Variable Analysis. Tan HE, Santa Maria PL, Eikelboom RH, Anandacoomaraswamy KS, Atlas MD. Otol Neurotol. 2016 Aug;37(7):838-46.
3. Tympanoplasty for Chronic Tympanic Membrane Perforation in Children: Systematic Review and Meta-analysis. Hardman J, Muzaffar J, Nankivell P, Coulson C. Otol Neurotol. 2015 Jun;36(5):796-804.
The image below shows a total perforation of the tympanic membrane:
