Tympanic membrane perforation

Spec/a/senses - Conjunctivitis, earache, photophobia, tinnitus, tympanic membrane perforation, vision abnormal. 

Chronic suppurative otitis media is an inflammatory condition of the middle ear. The presence of a tympanic membrane perforation or a tympanostomy tube allows drainage into the external ear canal. Increased vascularity of the mucosa and submucosa, combined with acute and chronic inflammatory cells, is its hallmark. Granulation tissue, fibrosis, and osteoneogenesis are also commonly present. The granulation tissue contains neutrophils and plasma cells associated with small blood vessels and fibroblasts. ... 

Antimicrobial otic drops should be used with caution in the presence of a tympanic membrane perforation because of the potential for ototoxicity. In the case of suppuration, the ear canal should be cleaned before drop instillation. Purulence within the ear canal will not allow ototopical drops to penetrate the skin, and it is thus prevented from treating the ear infection. Ear cleaning is extremely important when suppuration occurs. 

The ototopical antimicrobial preparations stated earlier suffice for most cases of otitis externa and selected cases of chronic suppurative otitis. However, these compounds have a limited effect in certain patients with resistant strains of bacteria, drug-induced allergies, or a tympanic membrane perforation that requires administration into the middle ear space. In the last case, ototopical preparations may cause pain because of the acidic pH or the presence of alcohol. Ototoxicity of neomycin, polymyxin B, and colistin is also of concern, and many otolaryngologists prefer topical ophthalmic preparations.f Ophthalmic preparations are discussed in the article Ocular Drug Formulation and Delivery in this volume. 

In children with tympanic membrane perforation, topical ciprofloxacin caused no signs of local intolerance or... 

Dvorak, D., Abbas, G., Ali, T., Stevenson, S., Welling, D., 1995. Repair of chronic tympanic membrane perforations with long-term epidermal growth factor. Laryngoscope 105,... 

Fina, M., Bresnik, S., Baird, A., Ryan, A., 1991. Improved heahng of tympanic membrane perforations with basic fibroblast growth factor. Growth Factors 5, 265—272. 

Kato, M., ladder, R.K., 1996. Repair of chronic tympanic membrane perforations with hbro-blast growth factor. Otolaryngol. Head Neck Surg. 115, 538—547. 

Konakfi, E., Koyuncu, M., Unal, R., Tekat, A., Uyar, M., 2004. Repair of subtotal tympanic membrane perforations with Seprafilm. J. Laryngol. Otol. 118, 862—865. 

McFeely, W., 2000. Tympanic membrane perforation repair using AUoDerm. Otolaryngol. Head Neck Surg. 123, 17-21. 

Spiegel, J., Kessler, J., 2005. Tympanic membrane perforation repair with acellular porcine submucosa. Otol. Neurotol. 26, 563—566. 

Another animal experiment in chinchillas found that application of aluminium acetate (0.5%)/benzalkonimn chloride (0.03%) otic solution causes hearing loss when a tympanic membrane perforation exists [54 ]. 

Ten-day courses are recommended for children older than age 2 years and in recurrent otitis AI-AIII media, or otitis media with perforated tympanic membrane. 

I Contraindications Hypersensitivitytoaceticacidoranyoftheingredients.Perforated tympanic membrane is frequently considered a contraindication to the use of any medication in the external ear canal. 

Contraindications Hypersensitivity to benzocaine or ester-type local anesthetics, perforated tympanic membrane or ear discharge (otic preparations)... 

Iontophoresis in the ear to relieve pain was reported by Albrecht in 1911 [47]. He used cocaine in high concentrations (20%-40%), copper electrodes, and uncontrolled high current (1.5-2 mA) on perforated tympanic membranes. Despite excellent anesthesia, many of his patients were vertiginous during and after treatment, with some patients suffering permanent loss of hearing. However, relatively recent studies have demonstrated that the use of lidocaine [48], A-acetylcysteine [49], or dexamethasone and fosfomycin [50] in iontophoresis to the ear has no adverse effects in either animal or clinical trials. Echols et al. [51] confirmed that lidocaine could be iontophoresed in the middle ear for at least 30 minutes at 1 mA without any adverse effects. 

Isopropyl alcohol is used to rinse the ear canal in patients prone to the development of external otitis. It is commonly applied after swimming as a prophylactic measure. Although isopropyl alcohol has broad bactericidal activity, it is widely used as a drying agent for the external ear canal. It displaces water left in the ear canal after swimming. Application into the middle ear space causes severe pain, and it should not be used in the presence of a perforated tympanic membrane. 

Topical preparations for the treatment of otomycosis should not be used in the presence of a perforated tympanic membrane. 

In the presence of an intact tympanic membrane, ototoxicity is less important, because the preparation has to be systemically absorbed for an ototoxic effect to occur. This issue is most relevant in cases of chronic suppurative otitis media with a perforated tympanic membrane for which the ototopical medication has the potential to reach the inner ear via the middle ear. Placed within the middle ear, ototopical medication may diffuse across the oval or round window, resulting in inner ear absorption. These windows consist of a thin membrane separating the middle ear space from the inner ear fluids. There is controversy regarding the clinical relevance of ototoxicity in cases of chronic suppurative otitis media. 

A variety of otic preparations have been reviewed here, including indications, side effects, and limitations. The ideal cerumenolytic compound has not yet been developed, nor has a cerumen replacement product. Antiseptics enjoy wide application but are limited when used in the presence of a perforated tympanic membrane. Available antifungal medications appear to be adequate for the treatment of otomycosis, although none have been approved as otic preparations. The limitations of the otic antimicrobial drops have been stated, including the potential both for organism resistance and for ototoxicity. The recent introduction of Floxin and Cipro HC products make available better otic antimicrobial drops for treatment... 

Gentamicin ear-drops can cause serious adverse effects (for example vertigo, imbalance, ataxia, oscillating vision, hearing loss, and tinnitus) when they are used by patients with perforated tympanic membranes or tympanostomy tubes (8). 

HA preparations with various viscoelastic properties promote healing of perforated tympanic membranes [151,152], Films of HA esters, such as HYAFF provided by Fidia, Inc. (Abano Terme, Italy) are used in ear and sinus surgery. These preparations promote wound healing of the tympanic membrane, facilitate re-epithliazation, as well as prevent adhesion between layers of mucous tissues. 

Ofloxacin interferes with microbial DNA synthesis. It is indicated in the treatment of acnte bacterial exacerbations of chronic bronchitis, commnnity acquired pneumonia, uncomplicated skin and skin structure infections, acute uncomplicated urethral and cervical gonorrhea, nongonococcal urethritis, cervicitis, acute pelvic inflammatory disease, uncomplicated cystitis, complicated urinary tract infections (UTI), and prostatitis cdiV eAhy Escherichia coli. Ophthalmic use for treatment of conjunctivitis and corneal ulcer infections caused by susceptible organisms otic use for treatment of otitis externa, chronic suppurative otitis media in patients with perforated tympanic membranes, and acute otitis media in pediatric patients with tympanostomy tubes. 

Recently, interest in the CT study of the middle ear has been renewed by detailed endoscopic studies of this region performed during interventions with dedicated devices this technique has been called transtympanic endoscopy, since it requires the perforation of the tympanic membrane. 

The history of real endoscopy of the middle ear was started in 1967 by Zini when he tried to visualize the middle ear using a system of micromirrors, which allowed the exploration of the retrotympanum. This method, called indirect microtympanoscopy, is still used in clinical practice. Mer et al. (1967) introduced the fiberoptic endoscope into the tympanic cavity through a perforation of the tympanic membrane. Marquet and Boedts D (1975) described an endoscopic technique based on the use of a 1.7-mm... 

Transtympanic endoscopy can be used as a diagnostic tool or as guidance for otosurgical interventions. In the first case the easy access of the external auditory canal allows the visualization of the tympanic membrane, a barrier between the endoscope and the middle ear only the presence of a pathologic or surgical (miringotomy) perforation permits a limited exploration of the tympanic cavity. 

Lou, Z., Tang, Y., Wu, X., 2011. Analysis of the effectiveness of basic fibroblast growth factor treatment on traumatic perforation of the tympanic membrane at different time points. Am. J. Otolaryngol. 33, 244—249. 

McFadden SL, Ding D, Jiang H, Woo JM, Salvi R (2002) Chinchilla models of selective cochlear hair cell loss. Hear Res 174(l-2) 230-238. doi 10.1016/80378-5955(02)00697-4 Mehta R, Rosowski J, Voss 8, O Neil E, Merchant 8 (2006) Determinants of hearing loss in perforations of the tympanic membrane. Otol Neurotol 27(2) 136-143. doi 10.1097/01jnao. 0000176177.17636.53... 

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