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Anatomically, ear drum is a structure that separates middle ear and outer ear canal. When there is any rupture or hole on the eardrum due to variety of reasons, it is called “eardrum perforation”. Middle ear is connected to the nose and pharynx via eustachian tube. This way, middle ear pressure is equalized with external environment pressure.

What are the causes of eardrum perforation?
Holes in the eardrum usually occur following a trauma or infection. Holes occuring post-trauma;

1. Inserting a foreign object into the ear
2. Skull fractures
3. Sudden and forceful explosions
4. Intrusion of acidic or such caustic substances into the ear canal
5. Strikes onto the ear

Traumatic eardrum ruptures
In most cases, an eardrum rupture that occured due to a trauma, heals on its own within weeks; but rarely, might last for months. During that recovery period, ear should be protected from water and trauma. If the rupture does not recover on its own, then it is surgically repaired. Acute middle ear inflammations might cause pain, hearing loss or spontaneous perforation. In such cases, ear generates a bloody discharge. With the acute middle ear inflammations, fullness sensation in the ear, decreased hearing, pain and fever are  common symptoms. When the ventilation (aeration) tube falls out on its own or removed by a physician, rarely a tiny rupture stays in the eardrum. On the other hand, when patient is suffering from chronic middle ear inflammation, the rupture in the eardrum has more definitive borderlines , as if it was punctured with a stapler. There is no pain. If not infected, then there is no discharge either. Decrease of hearing is the most apparent complaint.

How does the eardrum affect hearing?
Usually there is direct proportionality between the size of the rupture and the decrease of hearing. If the rupture is big, hearing loss is more, if the rupture is small, then the loss is less. Also the location of the rupture is as important as the size of it. Especially with the ruptures behind the eardrum, hearing loss is more. As for the serious head traumas (especially with fractures), hearing loss can be significant if the fracture line is coinciding with the structures which are important for the transmittance of the sound.
If the eardrum perforation is caused by an acute trauma or an explosion, then the hearing loss might be excessive and a severe ringing might emerge.  In such situations,
usually the hearing partially improves and ringing diminishes day by day. However, if there is chronic infection, then the hearing might decrease gradually.

What will be the doctor’s approach, if I have eardrum perforation?
If the rupture is small, then the ENT specialist could follow-up on (observe) the rupture. Sometimes small ruptures close up on their own, without having to operate on them. Other than that, he could patch up the rupture either in his office or in the hospital. This procedure is performed under microscope. By way of smearing a chemical substance around the rupture or with the use of special instruments, bleeding is induced in that location to stimulate cell growth and afterwards a patch is placed on the rupture. In most cases, hearing improves by the repair of the rupture. Sometimes it may be necessary to repeat that procedure 3-4 times until the rupture is fully repaired. If your doctor concludes that the rupture won’t close with a patch, then he might recommend you closing of the rupture with surgery. He will have you take a hearing test before the operation to determine the severity of your hearing loss. Hearing test results may change the nature of the operation. There are various surgery techniques. These methods are called “tympanoplasty” in general. Surgical methods are substantially successful in rupture repair and hearing improvement.

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