A hole in the drum. An overview of tympanic membrane perforations.
BACKGROUND
Tympanic membrane perforations are common and can be categorised into either acute or chronic. Acute perforations are usually traumatic or inflammatory in origin and heal spontaneously. Chronic perforations may be associated with underlying progressive disease.


OBJECTIVE
To differentiate between safe and unsafe perforations and describe management principles for these conditions.


CONCLUSIONS
The majority of acute tympanic membrane perforations heal spontaneously. Those that do not can be considered for surgical repair. Chronic perforations should be viewed as either safe or unsafe depending on the risk of progression to significant complications. Unsafe perforations are often associated with cholesteatoma (an epidermoid cyst of the middle ear and mastoid air cell system). Cholesteatoma destroys bone and causes serious ear and intracranial complications--surgery is commonly required.
Fagan
Paul
P
Department of Otology and Neurotology, St Vincent's Hospital, Sydney, New South Wales. pfagan@ozemail.com.au
Patel
Nirmal
N
D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D018424:Cholesteatoma, Middle Ear / Q000150:complications / Q000473:pathology; D003907:Dexamethasone / Q000627:therapeutic use; D004338:Drug Combinations; D005601:Framycetin / Q000627:therapeutic use; D006096:Gramicidin / Q000627:therapeutic use; D006801:Humans; D018058:Tympanic Membrane Perforation / Q000188:drug therapy / Q000209:etiology / Q000473:pathology / Q000601:surgery
D000891:Anti-Infective Agents, Local; D004338:Drug Combinations; D006096:Gramicidin; D005601:Framycetin; C023881:Sofradex; D003907:Dexamethasone