Damage to the eardrum: symptoms and treatment. The role of the eardrum in the transmission of sound signals

Rupture or perforation of the eardrum is damage to the membrane due to exposure to a large number of unfavorable factors. Under the influence of mechanical, physical, chemical or thermal reasons, a gap is formed, which disrupts a person’s ability to fully hear sounds. Sometimes self-recovery of the membrane is observed, but only with minor damage. With more severe trauma, a scar may remain, and in particularly severe situations, any violation of integrity can lead to hearing loss.

There are quite a few predisposing factors that can lead to such a disorder. All of them can be divided into several groups. But the most common factors for damage to the membrane are inflammation in the middle ear, exposure to pressure, sudden and unexpected noise, injury while cleaning the ear with objects not intended for this purpose, the pathological influence of hot liquids both at home and at work, as well as penetration foreign objects into the ear.

Any violation of the integrity of the eardrum is accompanied by the manifestation of unpleasant symptoms. Symptoms of a ruptured eardrum are pain of varying intensity and character, a feeling of fullness in the damaged ear, the occurrence of tinnitus, decreased hearing, up to its complete loss.

Diagnosis of such a disorder involves performing a series of instrumental examinations. When discharge appears, a laboratory study of the contents is carried out. Treatment for perforation of the eardrum consists of using medications or performing medical plastic surgery. The choice of therapy method is based on the volume of damage.

Etiology

As mentioned above, a ruptured eardrum can occur from a large number of causes, which are divided into several groups. The first group consists of mechanical factors, which include:

wide range of ear injuries;
accidental or intentional penetration of a foreign object into the ear cavity;
unqualified performance of medical procedures aimed at removing the ear plug;
cleaning the ear with objects not intended for this process;
traumatic brain injuries.

Physical damage can occur when:

pressure difference in this area. This can happen due to severe coughing or sneezing, as well as temperature changes during airplane flights or diving;
falling on the ear;
strong blows to the ear;
unexpected noise.

The last group of factors is thermal, which can lead to perforation of the eardrum, including:

ear burns. They can be of a domestic or industrial nature;
toxic or chemical substances entering the ear.

A little-known group of injuries is military, which includes shrapnel and bullet wounds.

In addition, diseases can become factors in the formation of such a disorder. In particular, such as acute course or chronic course. Certain factors can lead to either minor trauma to the membrane or its complete destruction.

Symptoms

Immediately after the rupture of the eardrum, a pronounced pain syndrome appears, which passes after some time or other symptoms appear against its background. The following clinical manifestations come to the fore:

appearance and ;
a feeling of discomfort in the form of ear congestion;
the occurrence of bloody or purulent discharge, often with an unpleasant odor;
partial decrease or complete loss of hearing;
increased body temperature;
attacks of nausea and dizziness;
disorientation;
decreased appetite;
sleep disorders;
perforation;
episodes of loss of consciousness;
the release of air from the auricle indicates a completely perforated membrane.

The severity of symptoms of eardrum perforation depends on the intensity of the lesion. Minor trauma, affecting only the outer layer and a small part of the middle layer, does not entail hearing loss or the appearance of other signs. Moreover, such damage can be eliminated on its own, which is observed in almost half of the patients. Severe damage is often accompanied by fractures of the auditory ossicles or injury to the internal muscles. With such a lesion, intense expression of symptoms is observed.

Complications

If you ignore the symptoms, as well as if you provide unqualified or incomplete therapy, the consequences of a ruptured eardrum may occur. These include:

spread of the inflammatory process to the entire area of the inner ear;
feeling of some unpleasant symptoms in the healthy ear;
nerve neuritis;
and – develop only when pathological microorganisms enter the affected area;
temporary memory loss;
discharge of cerebrospinal fluid from the ear opening - in cases where the cause of the lesion was a traumatic brain injury;
structural disorders of some elements of the auricle.

If the tear is large, complete hearing loss may occur.

Diagnostics

An ENT doctor knows what perforation of the eardrum is - it is this specialist who carries out the diagnosis and prescribes treatment tactics. Before conducting instrumental and laboratory examinations, the doctor must perform several manipulations. In particular, get acquainted with the patient’s medical history and life history. This is necessary to find the causes of the disease. Palpation and careful examination of the affected area using special instruments is also necessary. This will enable the doctor to determine the extent of the eardrum rupture, as well as identify the presence and intensity of symptoms.

Instrumental diagnostic methods include:

otoscopy – study of the affected area and ear canal, search for membrane deformations. It is carried out using special devices from an otolaryngologist - an ear specula, an otoscope and a frontal reflector;
CT is a way to fully visualize all layers of the ear;
audiometry is a procedure for studying hearing acuity. Allows the doctor to determine the degree of hearing loss or diagnose complete hearing loss.

Laboratory tests consist of performing a general blood test, as well as a microscopic examination of purulent or mucous fluid secreted from the auricle.

Treatment

After a ruptured eardrum, it is necessary to transport the victim to a medical facility as soon as possible. Before this, you cannot provide first aid yourself. In particular, apply cold to the affected ear, rinse it, and remove blood clots or purulent fluid. The only thing you can do on your own is to put dry cotton wool in the damaged ear and bandage it. For severe pain, painkillers can be given.

Professional treatment of eardrum perforation consists of several manipulations:

elimination of bleeding;
cauterization - used only for minor ruptures;
promoting the free outflow of purulent or mucous fluid;
infusion of antimicrobial drugs into the ear cavity using a catheter;
installing a patch – used to repair only minor damage to the membrane.

Drug therapy consists of prescribing:

a course of antibiotics - in the form of ear drops or tablets;
vasoconstrictor drugs;
mucolytics;
anti-inflammatory drops.

In particularly severe situations, when the eardrum is perforated, surgical intervention is resorted to. This is necessary in cases:

complete rupture of the membrane;
partial hearing loss;
impaired mobility of the auditory ossicles.

There are several ways to treat this disorder with surgery. For this purpose they can assign:

myringoplasty - the intervention consists of replacing the membrane with a flap taken from the temporal muscle. Sutures are applied with threads, which dissolve on their own after a few weeks;
ossiculoplasty is an operation to restore the auditory ossicles, often with their prosthetics. The procedure is carried out only under local anesthetic;
tympanoplasty – removal or implantation of artificial auditory ossicles.

Often, traditional medicine is used in treatment, which should be used only after consulting a specialist. They promote rapid healing.

Prevention

To prevent a person from having problems with a ruptured eardrum, it is necessary to adhere to several rules:

clean your ears only with cotton swabs intended for this purpose;
ensure that foreign objects do not enter the ear, especially in children, and do not remove them yourself;
avoid exposure to strong noise;
do not fly on airplanes or dive into deep water during exacerbations of ear diseases;
When the first symptoms occur or fluid comes out of the ear, you should immediately contact a specialist.

The prognosis of the disease directly depends on the degree of membrane rupture. With minor damage, spontaneous healing occurs in half of the patients. An unfavorable outcome occurs as complications progress, as well as in cases of damage to the auditory ossicles or bacterial infection. This can lead to complete loss of hearing, which, in turn, requires surgery to restore it or the installation of a hearing aid.

EARDRUM (membrana tympani, myrinx) - a thin, elastic membrane that separates the external auditory canal from the tympanic cavity.

The existence of the eardrum has been known since the time of Hippocrates, who in his writings mentions it as a membrane that resonates with sound and is of great importance for hearing. In the 19th century, H.J. Schrapnell, J. Toynbee, A. Troltsch, A. Politzer, I.I. Nasilov, A.F. Prussak conducted an in-depth study of the normal and pathological anatomy of the tympanic membrane . The foundations of the physiology of the eardrum were laid in the 60s of the last century by the German scientist H. L. Helmholtz.

In humans, the eardrum is of ectodermal origin and develops from the first gill pouch at the beginning of the 6th week of intrauterine life. Improper formation of the temporal bone can lead to malformations of the eardrum. Sometimes its connection with the malleus is absent, isolated underdevelopment of the loose part of the tympanic membrane is observed, or instead of the tympanic membrane there may be only a bone plate.

Anatomy and histology

The eardrum has an irregular oval shape, its size along the horizontal axis is 8-9 mm, along the vertical axis - 9-10 mm. Thickness - 0.1 mm. It is tightly fixed in the tympanic groove of the temporal bone (sulcus tympanicus) with its thickened fibrocartilaginous ring (anulus fibrocartilagineus). In the upper section, the ring is absent and the eardrum is attached to a small bony notch. The eardrum occupies an inclined position relative to the axis of the external auditory canal, forming an angle of 40-50° with its upper wall, 30° with the lower wall, 27° with the anterior wall, and 140° with the posterior wall. In newborns, the eardrum occupies a more horizontal position. The main part of the eardrum, enclosed in a bone ring, is called stretched (pars tensa), the remaining, much smaller part is called loose (sagging) (pars flaccida) or shrapnel left membrane (membrana Schrapnelli). The boundary between these parts is the anterior and posterior malleus folds (plicae malleolares ant. et post.), which externally start from the ends of the incisura tympanica and end at the short process of the malleus, attached to the inner surface of the tympanic membrane. Through a normal tympanic membrane, one can see a slightly protruding short process and the handle of the malleus, which extends further downward and posteriorly, also attached to the inner surface of the tympanic membrane. (see Otoscopy). Due to the fact that the handle of the hammer is deflected inward by approximately 30°, the eardrum is also retracted inward in a conical manner. The place of greatest retraction (up to 2 mm) corresponds to the end of the handle and is called the navel of the eardrum. (umbo membranae tympani). The eardrum has a grayish-pearl color. Under artificial light, a shiny triangular spot appears in the anterior-inferior section of the eardrum, the apex of which rests on the navel area and is called a light cone (color. Fig. 1). The eardrum consists of three layers (Fig. 1): the outer layer, which is a direct continuation of the skin of the external auditory canal, the inner layer, which is a continuation of the mucous membrane of the tympanic cavity, and the middle fibrous layer. The fibrous layer is formed from outer radial and inner circular fibers. Between them there are parabolic fibers. In the area of the loose part of the membrane, there is no fibrous layer, and instead there is loose connective tissue rich in elastic and collagen fibers. The outer layer of the tympanic membrane is innervated by branches of the auriculotemporal nerve (n. auriculotemporalis), the inner layer is innervated by the tympanic plexus (plexus tympanicus). The outer layer of the tympanic membrane receives vessels from the deep ear artery (a. auricularis profunda), the inner layer - from the tympanic artery (a. tympanica) and stylomastoid (a. stylomastoidea). The veins of the outer layer of the eardrum drain into the deep auricular vein; mucous layer - into the stylomastoid vein. The veins of the outer layer of the tympanic membrane widely anastomose with the vessels of the mucous layer. The outer subepithelial layer is especially richly represented by vessels; the vessels in it (with the exception of the posterosuperior quadrant) have a strictly radial orientation (Fig. 2). The closest regional lymph nodes lie on the sternocleidomastoid muscle.

Physiology

The eardrum mainly performs two functions: it transmits sound vibrations through the chain of auditory ossicles to the oval window of the labyrinth to the foot plate of the stapes and at the same time protects the round window of the labyrinth from sound vibrations (see Inner ear). As a result of these functions, different sound pressures are transmitted to the labyrinthine windows, which creates conditions for vibrations of the ear lymph and irritation of the endings of the auditory nerve. The transformation (amplification) of the sound of the eardrum is carried out due to its conical shape. The amplitude of vibration of the eardrum between the navel and the periphery is much greater than in the navel region, as a result of which the navel region and the chain of auditory ossicles vibrate with greater force than the original sound wave. The strength of sound vibrations is also increased due to the fact that sound from the large surface of the eardrum is concentrated on a small area of the foot plate of the stapes, which is 20-25 times smaller than the eardrum. In the absence of an eardrum and auditory ossicles, hearing impairment reaches 20-30 dB.

Pathological changes

Pathological changes in the eardrum most often occur as a result of diseases of the tympanic cavity or external auditory canal. Less common are independent diseases of the eardrum - damage and inflammation. If the ventilation of the tympanic cavity is impaired due to a pathological condition of the auditory (Eustachian) tube (see Tubo-otitis), the tympanic membrane is retracted, it loses its luster, and its contours are defined more sharply (color fig. 2). With adhesive otitis and tympanosclerosis (see), the eardrum thickens, and calcareous deposits (petrificates) or fibrosis appear in its thickness. Acute inflammation of the middle ear (see Otitis) first causes a slight injection of the vessels of the eardrum (tsvetn. fig. 3), then the redness spreads to the entire eardrum, it is infiltrated, sometimes bulging with exudate (tsvetn. fig. 4). In chronic purulent otitis media, there is always a persistent perforation in the eardrum (color fig. 5-7). When the eardrum is injured, its ruptures and often complete destruction are observed. At the moment of rupture, sharp pain, noise in the ear, and sometimes fainting appear. Hearing decreases. If infection does not occur, ruptured eardrums heal quickly. Treatment boils down to protecting the middle ear from infection. When the eardrum is burned by chemicals, hot liquid or steam, its redness and formation of blisters are noted, with deeper burns - necrosis and destruction. Severe pain caused by burns is calmed with analgesics, and the blisters are opened. Damage to the eardrum due to a sudden change in barometric pressure - see Barotrauma. Primary isolated inflammation of the eardrum - see Myringitis. Surgeries on the eardrum are mainly of two types: an incision to ensure the outflow of pus in acute purulent otitis media (see Paracentesis) and plastic surgery to restore the integrity of the eardrum (see Myringoplasty).

Artificial eardrum

An artificial eardrum is a prosthesis that replaces the eardrum or covers its perforations and is used to improve hearing. Dry perforations of the eardrum are sealed with chicken egg film, thin rubber, etc. In case of large destruction of the eardrum, prostheses made of polymer materials resembling the shape of an eardrum are used, which, as a rule, significantly improve hearing, but often lead to infection. To improve hearing, a cotton ball soaked in liquid oil is successfully used and placed in the area of the labyrinth windows. A humid environment promotes the transmission of sound vibrations to the inner ear. To avoid infection, the cotton ball must be changed frequently. Better results come from hearing-improving surgeries.

Bibliography: Diseases of the ear, nose and throat, ed. G. M. Kompaneets and A. A. Skripta, vol. 1, part 1, Kyiv, 1936; Vulshtein X. Hearing-improving operations, trans. from German, M., 1972; Gaudin E. P. On the mechanism of action of tympanic prostheses, Zhurn. ear, nose and throats, Bol., No. 3, p. 69, 1969; Kalina V.O. Embryology and anatomy of the ear, Multivolume. Guide to otorhinolaryngology, ed. A. G. Likhacheva, vol. 1, p. 100, M., 1960; Kobrak G. G. Middle ear, trans. from English, M., 1963; Levin V.N. On the micromorphology of the vessels of the human middle ear, in the book: Morphol, fundamentals of microcirculation, ed. V. V. Kupriyanova, V. 2, p. 144, M., 1967; Khechinashvili S.N. Questions of theory and practice of auditory surgery, Tbilisi, 1963; L im D. J. Human tympanic membrane, Acta oto-laryng. (Stockh.), v. 70, p. 176, 1970.

N. V. Zberovskaya, N. N. Usoltsev; V. N. Levin (anat.).

The eardrum is a weakly stretchable and slightly pliable membrane that separates the outer ear from the middle ear, which acts as a barrier to the penetration of microorganisms, foreign objects and liquids deep into the ear. Its main function is the transmission of sound vibrations.

What does the membrane consist of?

The eardrum has a strong structure, thanks to which it can withstand pressure significantly higher than atmospheric pressure. It has a three-layer structure and consists of:

squamous epithelial cells, which are a continuation of the integumentary tissues of the ear;
interweaving of fibrous fibers;
single-layer mucous membrane.

Thanks to the interweaving of fibrin fibers, the eardrum has a strong and tensile structure. Radial fibers are well developed and extend from a common center to the edges of the membrane. Circular (circular) are located only along the edge and pass into the tissue of the periosteum of the tympanic ring.

Its elastic properties are maintained by constant temperature and humidity, maintained due to the structure of the ear canal. These indicators in the ear, near the eardrum, do not change when weather conditions outside fluctuate.

The outer part has a small recess towards the inner ear (trillet recess). The most concave part of the membrane is called the umbilicus. It is located slightly below the center of the membrane.

The main part of the membrane is attached to the bony groove of the tympanic ring and is stretched tightly. The smaller part, located between the ends of the tympanic notch (Rivinus), is relatively free and is called the shrapnel membrane. In this part, the eardrum consists of two layers without a connective tissue layer. The shrapnel membrane is externally bounded by epithelial (trailer) folds. They extend from the malleus protrusion and enter the tympanic cavity.

From the navel to the free edge, the eardrum has an S-shaped protrusion, which is formed by the underlying handle of the malleus - the malleus strip.

Location and innervation

This membrane is located at the end of the external auditory canal, and on the reverse side it is adjacent to the tympanic chamber. In adults, it is attached at an angle to the bone of the ear canal. In the upper part, the angle is about 140° and the slope goes towards the inner ear, and in the lower part it is 27°, the slope goes towards the outer ear. In newborns the slope is greater than in adults, and in the human embryo it is inclined almost horizontally.

On the side of the tympanic chamber, a complex hinge system is adjacent to the membrane - the malleus, the incus and the stirrup.

To make it easier to describe the structures, the drum membrane is divided into squares. The vertical axis runs along the handle of the hammer from top to bottom, the horizontal axis goes through the protrusion (umbilicus) of the membrane. In the posterior-superior quadrant of the membrane, the handle of the malleus and the long process of the incus are visible. A stirrup can be seen behind them.

The innervation of the membrane is carried out by branches of the auditory nerve. Dividing into several branches, the nerve endings form a network that penetrates both epithelial layers of the membrane.

Blood supply occurs on both sides of the ear membrane. Externally, a network of capillaries comes from the deep auricular artery, running along the handle of the malleus. The internal network consists of vessels arising from the stylomastoid and tympanic arteries. The outflow of blood occurs through veins, which are also located in the epithelial and mucous tissue of the membrane. The lymphatic network, lying under the layer of epidermis and mucous membrane, has anastomoses with each other.

Biophysical characteristics

The structure and location of the eardrum determine its functions. The funnel-shaped shape of the membrane enhances its resonant properties. The mesh structure of the intertwined fibers of the middle layer of the membrane also plays an important role. Its meaning was first described and studied by G. Helmholtz. Each radial fiber is stretched between the center and edge of the eardrum, the middle of the fiber is movable.

Fibers along their length vibrate with varying strength and frequency. The middle of the radial fibers trembles with greater frequency and less force than the ends. There the vibration force is greater with a smaller amplitude. The combination of radial and circular fibers constitutes a transforming system. As a result of the research, it was found that the inelastic part of the tympanic membrane, which lies at the center of the convergence of the radial fibers, vibrates with the same amplitude at a sound intensity of up to 2400 Hz; if the sound intensity exceeds this value, then the vibrations of the hammer handle lag behind the vibrations of the underlying membrane by almost 3-3. 4 times.

Sound vibrations transmitted to the lever system and further to structures in the inner ear decrease in amplitude but increase in strength. The elastic properties of the eardrum quickly return it to its original position. If the pressure increases gradually, the eardrum can withstand pressure of up to 2 atmospheres. In childhood, the membrane not only has a round shape, but also high elasticity. When breathing, the membrane vibrates with a slight amplitude, which is caused by the opening and closing of the opening of the Eustachian tube during inhalation and exhalation. The same mechanism reduces the formation of echo during conversation.

The size of the receptive surface of the membrane significantly exceeds the area of the oval window located in the inner ear. Accordingly, the pressure on the oval window increases. The lever mechanism of the auditory ossicles reduces the amplitude of sound waves and increases their strength. In addition, the structure of the outer ear increases the strength of sound. Thus, the impact on the oval window is enormous. Special protective mechanisms protect the inner ear from damage. There are two muscles in the middle ear: the tensor tympanic membrane and the stapes fixator. As the sound intensity increases, the muscles contract and reduce vibrations of the membrane and stapes, which protects against destruction.

The balance between external and internal pressure in the ear is maintained by the Eustachian tube. When the balance is disturbed, a person not only experiences unpleasant sensations, but also hears worse.

In the inner one there is a secondary membrane covering the oval window of the cochlea. Its function is to reduce vibrations of the scala tympani perilymph.

Functionality of the eardrum

The functions of the eardrum in a sound analyzer are not only to conduct sounds, but also to protect the receptors of the inner ear. The unique amazes with its perfection. The auricle helps focus sound into the long (21-27 mm) ear canal, which is a resonator and has its own vibration frequency. If the sound matches the ear canal's own resonance, then strong pressure is applied to the eardrum. Therefore, some sounds are perceived as unpleasant.

The natural frequency vibrations of the ear canal are, on average, 3000-4000 Hz. allows you to amplify the sound on the eardrum several times. In this case, not only the resonating properties are important, but also the reflection of sound from the eardrum. With age, the diameter of the ear canal changes, the elasticity of the eardrum decreases, and accordingly, the sound strength changes.

The structure of the hearing apparatus allows not only to perceive sounds in the range from 16-20 Hz to 15-20 kHz, but also to determine the direction of the sound.

With age, the upper range of sound perception decreases. There is also the ability to perceive sound without the participation of the eardrum due to its transmission through the bones of the skull directly to the cochlea.

When the fibers of the middle layer of the eardrum rupture, its integrity is not restored and the oscillatory ability is impaired, which leads to decreased or complete loss of hearing.

The eardrum is a thin membrane, the short one serves as a transmission mechanism, thanks to which a person can fully hear all sounds. Its main function is to transmit sound vibrations. The membrane, or membrane, is located deep in the middle ear and serves as a barrier to the penetration of pathogens. A membrane separates the middle and outer ears.

It is impossible to see it with the naked eye; for this you will need a special tool - an otoscope. However, it is quite easy to damage it; this can also happen if you clean it carelessly with a cotton swab or objects not intended for this. But in addition to injury (rupture or perforation), it also becomes inflamed. The anatomically incorrect shape of the eardrum, namely its retraction, is also considered a pathology.

Structural features

The eardrum is small in size, no more than 1 cm in diameter. It is adjacent to the walls of the ear canal, so its shape depends on the structural features of the ear canal. In children it is round in shape, but as they grow older it becomes oval because it stretches out.

At the back of the eardrum are the auditory ossicles; they take part in the act of transmitting sound waves. The tensor and stapedius muscles regulate the intensity of vibration of the eardrum. A string passes over the tendon of the guide muscle. The membrane has a complex structure, since it is not just a thin flap of skin.

It consists of 3 layers:

outdoor,
average,
internal.

The outer layer is based on epithelial cells, which are similar to those lining the ear canal. Epithelial cells are regularly renewed through exfoliation. If the integrity of this layer is accidentally damaged, it is capable of self-healing.

Superelastic fibrous tissue makes up the middle layer of the eardrum. It is very elastic and stretchable. Fibrous tissue has a mesh structure, its fibers are located simultaneously in two directions. If this layer ruptures, it will no longer heal.

The inner layer represents the mucous membrane of the membrane, due to which the membrane remains sufficiently moisturized and does not dry out. This layer has a high regenerating ability. Due to the fact that the membrane of the membrane has sensitive receptors, in case of injury or inflammatory processes a person feels pain and discomfort in the ear.

Regulation of the tension of the eardrum due to the smallest muscles in the structure of its membrane protects this auditory organ from sudden rupture. Thus, with sharp and loud sounds, an automatic reflex decrease in tension occurs, which manifests itself in a decrease in ear sensitivity.

The eardrum performs protective and auditory functions. The first is that it acts as a barrier, protecting against the penetration of pathogens and foreign particles.

The auditory function assumes that the eardrum is the main link directly involved in the transmission of sound vibrations.

The eardrum, being an important organ of hearing, has a complex structure

Inflammation of the ear membrane

Ear pathology such as myringitis or inflammation of the eardrum is a dangerous disease. It is caused by bacteria or a viral infection. Myringitis can also develop after colds, flu, pneumonia, tuberculosis or measles. Constant and prolonged exposure to mechanical irritants or chemicals can also cause a similar pathology.

Factors predisposing to such inflammation include heat, cold, water entering the ear and sudden loud sounds. Myringitis is not always an independent pathology. It often occurs against the background of diseases of the outer and middle ear. Therefore, the symptoms of inflammation of the eardrum are similar to them. The disease goes through 3 stages in its development:

initial. It is characterized by dilation of the vessels surrounding the eardrum.
stage of hyperemia. Dilated vessels become overfilled with blood, as a result of which their contours smooth out and protrude slightly. Edema of the myringa forms.
serous stage. Blisters filled with pus form on the surface of the eardrum. There may also be blood inside. As they mature, the bubbles open on their own.

The symptoms of myringitis depend on the type of disease; it can be hemorrhagic, acute or chronic. Hemorrhagic or bullous inflammation of the eardrum is often the result of influenza. Inflammation can develop within a few days after contracting the flu.

Pathology can be suspected by millet-like pimples formed on the surface of the external auditory canal, which contain hemorrhagic fluid inside. The patient complains of hearing loss, pain in the ear and bloody discharge from the ear canal.

The acute form of the disease is characterized by minor hearing loss, severity and tinnitus. The intensity of pain may increase. Acute meningitis itself is not accompanied by a rise in body temperature, but if such a symptom is present, it is associated primarily with the flu or cold, which were the root cause of myringitis.

It often happens that the acute form becomes chronic. In addition to this reason, myringitis develops as a result of inflammatory processes in the ear canal or eczema. In the latter case, the surface of the membrane becomes soaked and thickens under the influence of the formed purulent layer.

The main symptoms include mild dullness of hearing and a feeling of itching in the ear canal. An advanced form of chronic inflammation is accompanied by an unpleasant odor of discharge from the ear. Its most serious complication is complete hearing loss.

In children, inflammation of the ear membrane often occurs. This is due to the fact that they more often suffer from sore throats and colds, which cause complications in the ears. In infants and preschool children, inflammation of the eardrum can be suspected by the following symptoms:

headache or restlessness;
constant weakness and lethargy;
lack of appetite;
nausea and vomiting.

Inflammation of the eardrum is a common phenomenon.

Diagnosis and treatment of myringitis

The variability and similarity of symptoms of membrane inflammation with other ear pathologies significantly complicates the diagnosis of myringitis. Most often it is confused with otitis media. But with damage to the eardrum, in contrast, the patency of the Eustachian tube is not impaired.

To detect this, the pipe is blown out. But diagnostic procedures are not limited to this; it is necessary to conduct laboratory tests to identify the causative agent of the disease. A general blood test for this pathology will show leukocytosis with a shift to the left and an increase in the erythrocyte sedimentation rate.

The following indicators are diagnostically important:

maintaining the mobility of the eardrum;
absence of perforation noise during the blowing process;
minor hearing impairment.

To detect myringitis, an otoscopy is also performed. If it revealed swelling of the membrane and hyperemia, as well as smoothness of its structures, then this indicates acute inflammation. The chronic form of the disease is characterized by the presence of granulations, thickening of the walls of the eardrum, the formation of purulent blisters, swelling and softening of the epidermis. The most difficult thing to diagnose is chronic inflammation of the eardrum.

If otoscopy reveals bullous formations filled with exudate, then we are talking about hemorrhagic myringitis.

Treatment of myringitis must begin with eliminating the causes that caused the inflammation. Conservative therapy includes the use of the following categories of drugs:

antibiotics and antiviral agents. Targeted action against pathogens;
non-steroidal anti-inflammatory drugs. Eliminate inflammatory processes and relieve pain;
antiseptic solutions. Used to cleanse the ear canal of purulent contents.

If inflammation has led to the formation of large ulcers, then they must be removed surgically, followed by antiseptic treatment. The prognosis of myringitis depends on the causes that caused it, the therapeutic measures taken and the characteristics of the course of the underlying disease, against which the inflammation of the eardrum developed.

The hemorrhagic and acute form can be completely cured with the right therapeutic approach. The chronic version of inflammation is more difficult to treat. As measures to prevent this ear disease, experts note compliance with the rules of ear hygiene, prevention of damage and injury to the ear, timely treatment of diseases that can affect the eardrum.

Myringitis symptoms resemble otitis media

Retracted eardrum

Normally, the eardrum is slightly stretched. A retracted or concave membrane is considered a pathology and requires elimination. The reasons for this change in the shape of the membrane are different, but the symptoms and consequences are unchanged.

As a result of the retraction of the membrane, transudate or edematous fluid begins to accumulate in the middle cavity. If this pathology is not eliminated in a timely manner, then lymphocytes and neutrophils can penetrate into the transudate and lead to catarrhal otitis. The result of this process is hearing loss.

The retracted shape of the eardrum indicates a violation of the patency of the Eustachian tube. As a result of such an anatomical defect of the membrane, its functional mobility is lost, which makes it impossible to correctly transmit sound vibrations from the ear canal.

Retraction of the ear membrane has the following clinical manifestations:

hearing loss;
pain inside the ear;
feeling of fullness and heaviness in the ear;
pain while swallowing;
noise in ears.

This pathology must be eliminated. Retraction is the result of impaired ventilation inside the ear, which can be caused by pathologies such as eustachitis, otitis media, rhinitis, and barotrauma. When severe swelling appears, which leads to a significant narrowing or blocking of its lumen.

As a result, the ventilation channel is blocked and the membrane of the membrane is gradually drawn inward. The pathological processes that occur with otitis media also cause ventilation impairment as a result of swelling and accumulation of exudate at the entrance to the Eustachian tube.

With barotrauma, which is accompanied by a sharp drop in pressure, the eardrum does not have time to adapt to the changes that have arisen and is pulled inward. The retraction of the nose caused by a runny nose is mild and reversible.

This pathology can be detected using otoscopy, audiometry and acoustic impedance measurement. A retracted eardrum can lead to hearing loss and cause significant discomfort to a person. Hearing impairment occurs due to decreased sensitivity of the eardrum and impaired sound transmission.

You can get rid of this pathology with the help of complex treatment. For this purpose, the ENT doctor will prescribe the following measures:

blowing the auditory tube to restore the ventilation and drainage function of the Eustachian tube and normalize the pressure in the middle ear cavity;
if the cause is an inflammatory process, then antibacterial and anti-inflammatory drugs are prescribed;
the use of vasoconstrictors to eliminate swelling and opening of the Eustachian tube;
paracentesis or a procedure to remove fluid accumulated in the middle ear, the pressure of which has changed the shape of the eardrum.

The shape of the eardrum may be retracted and this can affect hearing.

Rupture of membrane

A rupture or perforation of the eardrum is a condition in which a hole or hole forms on the wall of the eardrum. There are 2 types of perforation: rim and edge. In the first case, the tissues in the area of the tympanic tubule retain their integrity. With a marginal rupture, all tissues of the membrane are affected, down to the bone.

This pathological condition can be the result of injury or inflammatory diseases of the membrane. In particular, experts identify the following reasons that can lead to such damage:

acute or chronic purulent otitis media;
barotrauma;
aerootitis;
fracture of the base of the skull;
direct mechanical damage.

Violation of the integrity of the eardrum as a result of injury is accompanied by sharp and severe pain, which gradually subsides. The pain syndrome is replaced by noise and congestion in the ears, bloody discharge from the ear canal may appear, and the victim notes a decrease in hearing.

If a complete rupture occurs, the person may feel air escaping from the affected ear when blowing their nose or sneezing. In addition, you will feel dizzy. If the perforation was a consequence of an inflammatory process, then the above-mentioned symptoms may be supplemented by the appearance of mucopurulent discharge from the ear canal and an increase in body temperature.

The following general symptoms are typical for a ruptured eardrum:

pain;
purulent mucous discharge;
serous-bloody discharge;
noise in ears;
decreased hearing acuity;
dizziness;
increased body temperature;
nausea.

Dizziness and nausea are the result of a disorder of the vestibular system. An increase in body temperature is observed if the cause of perforation is an acute inflammatory process. By the nature of the discharge, you can find out the cause of the rupture: if purulent discharge appears, this indicates an inflammatory disease.

Serous-bloody discharge distinguishes mechanical injury. Perforation of the eardrum can be detected using external examination and palpation, as well as otoscopy. It is important to take into account the size of the damaged area, the nature of the edges, the type of perforation and localization by squares.

Perforation of the membrane is accompanied by characteristic symptoms

Perforation treatment methods

With any damage to the integrity of the membrane, there is a high risk of infection entering the ear cavity. If such an injury occurs, the victim should not throw back or tilt his head. First aid in this case should be limited to inserting a sterile cotton or gauze turunda into the ear canal and fixing it with a bandage.

Under no circumstances should you wash or clean the wound yourself with anything. To receive medical care, a person must be taken to a hospital. After stopping the bleeding and removing the pus, a 1% solution of dioxidine, antimicrobial and antibacterial drops are poured into the ear.

Antibacterial therapy is carried out for 10 days, even if the victim’s condition has returned to normal. Antibacterial drugs such as Amoxicillin, Lincomycin, Spiramycin, Ciprofloxacin, Cipromed, Fugentin, Norfloxacin are used.

Swelling and hyperemia of the ear mucosa is eliminated through the use of vasoconstrictor drugs that are instilled into the nose. In addition, they restore and improve the ventilation and drainage functions of the auditory tube. Such drugs include Naphthyzin, Tizin, Galazolin, Sanorin.

If after perforation there is a copious discharge of thick exudate, then ACC and Fluimucil are prescribed for oral administration to thin it. For local anesthesia and disinfection, non-steroidal anti-inflammatory drugs are prescribed in the form of ear drops (Otinum, Phenazon, Otipax).

If a small part of the membrane is damaged as a result of perforation, it can close on its own, resulting in an invisible scar. If healing does not occur over a long period of time, surgery will be required. Surgical methods of treatment are resorted to if there is a violation of the integrity of the membrane as a result of injury or an acute inflammatory process, which is accompanied by impaired hearing and mobility of the auditory ossicles.

A ruptured ear membrane can be treated conservatively and surgically.

The operation is performed in 3 ways: myringoplasty, ossiculoplasty or tympanoplasty. In the first case, the eardrum is lifted using special instruments and a flap is applied to the perforation site. It is sutured with self-absorbing threads.

Ossiculoplasty is performed in case of hearing loss and with its help the sound translating system is restored. In this case, the damaged chains of the auditory ossicles are replaced with prostheses. The operation is performed using local anesthesia.

If perforation is accompanied by damage to the auditory ossicles, tympanoplasty is performed. It involves replacing damaged parts with special prostheses. After surgery, audiometry is recommended. This procedure is aimed at assessing hearing acuity.

To prevent eardrum rupture, it is necessary to promptly and correctly treat inflammatory diseases of the ear, carefully and carefully carry out ear hygiene, and take precautions when flying.

Damage to the eardrum- injury to the eardrum caused by mechanical, physical, thermal or chemical factors. Damage to the eardrum is accompanied by pain and congestion in the ear, tinnitus, and decreased hearing. The clinical severity of these manifestations depends on the strength of the traumatic factor and, accordingly, the degree of damage that occurs. Damage to the eardrum is diagnosed during otoscopy and microotoscopy; if a secondary infection occurs, bacterial culture of the discharge from the ear is necessary. Conservative treatment of damage to the eardrum includes freeing the ear canal from foreign bodies and blood clots, treating it with ethyl alcohol, prophylactic antibiotic therapy, and treatment of infectious complications. Surgical treatment consists of myringoplasty or tympanoplasty.

Causes of damage to the eardrum

Mechanical damage to the eardrum can be associated with ear trauma, a foreign body in the ear, unskilled attempts to remove wax plugs, or the use of objects not intended for this purpose (pins, matches, paper clips, etc.) to clean the external auditory canal. Damage to the eardrum is possible with traumatic brain injury, accompanied by a fracture of the temporal bone pyramid and disruption of the integrity of the tympanic cavity.

Physical factors that can lead to damage to the eardrum primarily include a sharp pressure difference inside the tympanic cavity and in the external auditory canal. Acoustic (barometric) damage to the eardrum is possible when falling on the ear, hitting the ear, sneezing violently with a closed nose, being in an explosion zone, carrying out diving or caisson work, testing in a pressure chamber, jumping into water from a great height. Acoustic damage to the eardrum occurs as a result of its excessive stretching, can have varying degrees of severity, and be accompanied by aerootitis and aerosinusitis. Barotrauma can cause structural damage to individual layers or elements of the eardrum; cause damage to the vessel passing through the membrane; cause complete rupture of the eardrum.

Thermal damage to the eardrum is usually accompanied by a burn to the auricle. It can be of a domestic and industrial nature (blacksmithing, pottery production, metallurgical workshops). Chemical damage to the eardrum occurs when caustic chemicals (acids and alkalis) enter the ear canal. Often it leads to the complete destruction of the eardrum and the entry of a caustic substance into the tympanic cavity, and through it into the inner ear. There is also military damage to the eardrum, which includes shrapnel and bullet wounds.

Signs of eardrum damage

The moment of damage to the eardrum is usually accompanied by severe pain in the ear. Then the pain syndrome may subside and complaints of hearing loss (hearing loss), noise in the ear and a feeling of fullness in it come to the fore. If damage to the eardrum causes it to rupture, patients may notice air escaping from the injured ear when they blow their nose or sneeze. The corresponding result can be obtained during the Valsalva maneuver. However, its implementation is not recommended due to the possibility of infection through the auditory tube in the presence of nasopharyngeal diseases such as pharyngitis, rhinitis, laryngitis, sinusitis, chronic tonsillitis, eustachitis, tonsillitis, ozena or adenoids.

The severity of clinical manifestations directly depends on how severe the damage to the eardrum has occurred. Minor damage to the eardrum, affecting only its outer layer or individual fibers of the middle layer, does not lead to noticeable hearing loss. It is characterized by rapid regression of pain and other symptoms. Extensive damage to the eardrum may be accompanied by a fracture of the auditory ossicles, dislocation or rupture of their joints, and injury to the internal muscles of the middle ear cavity. The most commonly observed ruptures of the incus-stapedial and malleus-incus joints, fractures of the legs and base of the stapes. Disturbances in the chain of auditory ossicles lead to the appearance of severe conductive hearing loss. A fracture of the base of the stapes is accompanied by intense ear noise and mixed hearing loss; Vestibular disorders and leakage of perilymph from the ear are possible.

Diagnosis of eardrum damage

Since damage to the eardrum accompanies 90% of ear injuries, its primary diagnosis is often carried out by traumatologists. However, for more qualified diagnosis and determination of optimal treatment tactics, patients with damage to the eardrum need to consult an otolaryngologist. The main and often sufficient method in diagnosing damage to the eardrum is endoscopic examination: otoscopy and microotoscopy. According to indications, audiometry, threshold audiometry, tuning fork examination, acoustic impedance measurement, electrocochleography, stabilography, vestibulometry, caloric test are performed to assess the function of the auditory and vestibular apparatus. Damage to the eardrum, complicated by secondary infection, is an indication for bacteriological examination of ear discharge.

Otoscopy for damage to the eardrum

With minor trauma, otoscopy reveals only an injection of the vessels of the tympanic membrane. Significant damage can be visualized in the form of subtotal defects, point and round perforations, slit-like ruptures or complete destruction of the eardrum. Ruptures and perforations of the tympanic membrane are characterized by uneven, scalloped edges. Through the perforation hole formed in the membrane, in some cases, during otoscopy, you can see the medial wall of the tympanic cavity and identify mucosal hyperemia characteristic of a fresh injury. Sometimes otoscopy diagnoses a hematoma of the tympanic cavity resulting from damage to the eardrum. With mechanical or acoustic damage, hemorrhages in the eardrum of varying severity, from isolated petechiae to massive hemorrhages, may be observed.

Some time after the eardrum has been damaged, a control otoscopy is performed. It is aimed at assessing the reparative processes occurring in the eardrum. Follow-up otoscopy may reveal scarring or persistent perforation. In some cases, a dense white formation is observed in the thickness of the eardrum, caused by the deposition of calcium salts in the rumen. Salt deposits can also be observed along the edge of the remaining perforation.

Treatment of eardrum damage

Uncomplicated damage to the eardrum does not require unnecessary intervention. Do not rinse the ear canal or put drops in the ear. If necessary, the foreign body is removed from the ear. If blood clots are present, they are removed with a dry cotton swab. To prevent infection, treat the ear canal with ethyl alcohol. If there is a risk of developing inflammatory complications of the middle ear, systemic antibiotics are prescribed. Damage to the eardrum complicated by secondary infection is treated in accordance with the principles of treatment of otitis media.

In cases where, after treatment of damage to the eardrum, a hole remains in it, surgical closure is indicated. For this purpose, tympanoplasty and myringoplasty are performed. Chick amnion, temporalis muscle fascia, meatotympanic flap, etc. can be used as a material to close the perforation. Recently, a method for closing the perforation using transplantation of cultured human allofibroblasts has been developed in otolaryngology. It is used if the perforation is more than 50% of the area of the eardrum and does not show signs of healing after 14 days from the date of damage.

Prognosis of eardrum damage

The outcome of damage to the eardrum depends on its size. Approximately 55% of patients experience spontaneous recovery of the eardrum. The best prognosis for spontaneous healing are slit-like ruptures of the eardrum, as well as perforations that occupy no more than 25% of its area. A small damage to the eardrum heals without leaving any traces. Significant damage to the eardrum is accompanied by scarring. Massive scar changes and calcification of the eardrum, as well as the presence of persistent residual perforation, are the causes of the development of conductive hearing loss.

Damage to the eardrum, combined with damage to the auditory ossicles or accompanied by infection, has an unfavorable prognosis for hearing restoration. In the first case, adhesive otitis media occurs in the tympanic cavity, in the second - various inflammatory complications. Such complicated damage to the eardrum leads to persistent conductive or mixed hearing loss, requiring hearing restoration operations or hearing aids with modern hearing aids.