Tympanic membrane perforation.pptx

Tympanic membrane perforation is a condition in which the membrane located between inner ear and middle ear

1. TYMPANIC MEMBRANE PERFORATIONS Abhilash Kumar BSc (N) 3rd year

2. INTRODUCTION ✓ TYMPANIC MEMBRANE PERFORATIONS also called as eardrum perforation is an injury of the TYMPANIC MEMBRANE . ✓ The tympanic membrane is a delicate, thin membrane present in the middle ear which is responsible for conducting the soundwaves to the inner part of the ear via vibrations . ✓ Damage to the eardrum can results in partial or complete hearing loss , tinnitus and other symptoms .

3. DEFINITIONS “Tympanic membrane perforation can be defined as a rupture or perforation (hole) of the ear drum which can occur as a result of otitis media , trauma , explosions , noise or surgery “ . “ According to Javed Ansari “ “ A perforated ear drum or punctured ear drum is a hole in the tissue that separates the auditory canal from inner ear . “ According to J.M Hawk “

4. ANATOMY AND PHYSIOLOGY OF THE MIDDLE EAR

5. ✓ EAR is the organ of hearing and balance . ✓ The human ear can be divided into 3 parts :- 1- External Ear 2- Middle Ear 3- Inner Ear EXTERNAL EAR : The external ear consist of :- (a) pinna or auricle .(b) external auditory canal

6. MIDDLE EAR : Middle ear is consist of : (a) Tympanic membrane .(b) Auditory ossicles .(I) malleus .(ii) incus .(iii) stapes INNER EAR : The inner ear is consist of the labyrinth .(a) cochlea .(b) vestibule .(c) semicircular canals

7. I NCIDENCE The prevalence of tympanic membrane perforation is 2.1 % among the general population totalling to 0.2 millions adolescents , 3.3 million adults and 2.8 million older adults . Both male and female are equally affected .

8. TYPES OF TM PERFORATION On the basis of location of the perforation ear drum perforation can be classified as : (a) Marginal perforation (b) central perforation (c) Attic perforation

9. MARGINAL TM PERFORATION : In marginal TM perforation the perforation occurs at the margins of the ear drum where the ear drum is attached to the auditory canal .

10. CENTRAL TM PERFORATION : The perforation occurs at the centre part of the TYMPANIC MEMBRANE

11. ATTIC TM PERFORATION : The perforation occurs at the superior part of the tympanic membrane.

12. Continued….. On the basis of cause of the perforation ear drum perforation can be of: (1) PATHOGENIC PERFORATION ; Pathogenic perforation of the tympanic membrane are caused by bacterial , viral , fungal infection (2) NONPATHOGENIC / TRAUMATIC PERFORATION ; Nonpathogenic perforation are those caused by physical, chemical or environmental agents

13. CAUSES / ETIOLOGY (1) FOREIGN BODIES (2) SUDDEN CHANGE IN ATMOSPHERIC PRESSURE (3) FALL INJURY (4) NOISE POLLUTION (5) INSECT MENIFESTATION (6) EAR INFECTION Streptococcus pneumoniae Nontypable heamophilus influenza Streptococcus pyogenes Staphylococcus aureus Varicella zoster virus etc

14. RISK FACTORS (1) chronic use of antibiotics (2) unhygienic practices (3) travel by air (4) underwater diving (5) sinusitis (6) prolonged use of headphones (7) Head injuries (8) Hard sneezing (9) Heavy lifting (10) upper respiratory tract infection

15. PATHOPHYSIOLOGY

16. CLINICAL FEATURES (1) OTALGIA (2) BLEEDING FROM EAR (3) FULLNESS OF EAR (4) HEARING LOSS (5) TINNITUS (6) DISCHARGE FROM EAR (7) FEVER (8) DIZZINESS AND DISORIENTION

17. DIAGNOSTIC EVALUATION (a) History collection (b) physical examination (c) otoscope (d) tympanogram (e) Weber test (f) Rinne test (g) Audiometry

18. OTOSCOPE

19. TYMPANOGRAM / TYMPANOMETRY

20. MANAGEMENT

21. MEDICAL MANAGEMENT NON PHARMACOLOGICAL MANAGEMENT : ✓. Hot application is applied to relieve discomfort . ✓. Aseptic cleaning of the acoustic canal is done . ✓. Swimming or allowing water into the ears is avoided until recovery . ✓. Prohibit nasal blow and ear drops . ✓. A water proof dressing should be applied over the affected ears .

22. 2. PHARMACOLOGICAL MANAGEMENT (A) ANTIBIOTICS MEDICATION : Tab . Amoxicillin 500 mg Tab . Amphicillin 450 mg (B) ANALGESIC MEDICATION : Inj . Diclofenac 75 mg Inj . Tramadol. 100 mg (C) ANTIPYRATIC MEDICATION : Tab . Paracetamol 550 mg (D) ANTIALLERGIC MEDICATION : Tab . Cetrizine 5mg Tab . Cyclizine 50 mg

23. SURGICAL MANAGEMENT (A) TYMPANOPLASTY / MYRINGOPLASTY : It is the surgical correction of the perforated eardrum . In TYMPANOPLASTY a graft is placed to restore the damaged tympanic membrane .

24. (B) OSSICULOPLASTY : The surgical procedure of reconstruction of ossicles with prosthesis to carry sound to inner ear is called OSSICULOPLASTY .

25. (C) TYMPANECTOMY : TYMPANECTOMY is the surgical removal of the tympanic membrane .

26. NURSING MANAGEMENT : NURSING DIAGNOSIS : Acute pain related to disease condition as evidence by facial expression . Altered auditory sense perception related to ruptured tympanic membrane as evidence by bleeding and hearing acuity Risk for infection related to EUSTACHIAN TUBE DYSFUNCTION as evidence by fever . Anxiety related to hospital environment as evidence by verbalization . Knowledge deficit related to disease condition as evidence by asking frequent questions

27. COMPLICATIONS Complete hearing loss Meningitis Mastoiditis EUSTACHIAN TUBE infection Tinnitus Ear discharge Headache Ossicular discontinuity Chorda tympani nerve injury DISORIENTION Drowsyness

28. PREVENTION AND HEALTH EDUCATION

29. SUMMARY

30. THANK YOU !! Seminar conducted by Abhilash Kumar