Ear Pic of the Week – TM Perforation Post Infection

Dr. Kenneth Deem, a Tacoma, Washington based ENT, is a first time contributor to the Tympanic Times.

Image of left ear drum with a persistent tympanic membrane perforation and infection. Taken by Dr. Kenneth Deem with the CellScope Oto

Image captured with CellScope Oto showing right ear drum with a persistent tympanic membrane perforation (indicated by arrow). Image was acquired after drainage and infection improved.

This Ear Pic of the Week shows a longstanding perforation in a 49 year old woman with recent right ear drainage. The drainage and infection improved after she used Ofloxacin antibiotic ear drops.

According to Dr. Deem, the infection was likely caused by water going through the ear canal, through the perforation and into the middle ear. The principal cause of tympanic membrane perforation is infection. Traumatic perforations occur from blows to the ear, severe atmospheric overpressure, exposure to excessive water pressure (e.g., in scuba divers), and improper attempts at wax removal or ear cleaning. Perforation with infection typically results in copious purulent drainage, as was reported by Deem’s patient, which may contain blood in both acute and chronic perforation.

In this case, the doctor notes that the perforation was likely caused long ago from a prior ear infection and difficulty with Eustachian tube function. Dr. Deem suggested the patient undergo a hearing test prior to considering repair of the TM with tympanoplasty, the suggested surgical treatment for tympanic membrane perforations. The left ear (not shown) displayed myringosclerosis and evidence of TM retraction related to a history of ear infections and Eustachian tube dysfunction.

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