- A ‘burst eardrum’ can occur for many reasons, including middle ear infections, ‘iatrogenic’ (eg previous grommets), or trauma (eg cotton bud, sharp objects, or even barotrauma or pressure change in flight). Rarely it is due to other medical conditions such as Wegener's Granulomatosis or other autoimmune conditions, or infections such as TB.
- The problems that result include decreased hearing, and recurring infections. Occasionally it can be the start of ‘cholesteatoma’, where skin cells move the ‘wrong’ way out of the ear canal, and instead find their way back into the middle ear.
- Treatment includes surgically closing the hole, but there are a few non-surgical options.
- Often the hole does not heal by itself because the middle ear keeps getting infected. Therefore, managing infections can sometimes help the hole to heal by itself. This includes keeping the ear dry and stopping water going down the ear canal, but can also include managing the ‘other end’ ie the nose. The nose is connected to the ear by the eustachian tube, and nose problems, stuffy and runny noses, sinus problems etc, can sometimes contribute to middle ear problems and burst eardrums
- The hearing can be affected by a hole. Repeated holes can cause scarring or thinning of the ear drum over time, and can then have a longterm effect on the hearing. If hearing is the main problem resulting from the burst eardrum, then hearing aids are a reasonable alternative to closing the eardrum surgically, particularly in older patients, whose natural hearing is decreasing in addition to the effect of the ear drum.
- If a hole is not closing by itself, it can be because the edges of the hole have scarred ie becomes chronic. 'Refreshing' the edges involves removing the scarred edge. Sometimes a hole will heal by itself when this is done. Other times, material is placed in the hole to act like a patch to help it heal eg fat, cartilage, gelfoam (a special surgical material), special paper. This is occasionally done under local anaesthetic, but often requires operating theatre.
- Then there is the surgical option which includes formally closing the hole in an operating theatre.
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