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Walter Reed National Military Medical Center
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- Advanced Computational Models of Hearing Loss
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- Development of Auditory Fitness-for-Duty Standards
- Evaluation of Advanced Hearing Protection Systems
- Multisensory Integration
- Recent Staff Publications
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Pediatric, Adolescent & Young Adult Medicine
Pediatric Primary Care
Adolescent & Young Adult Medicine
Preventive Care
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Children's Hospital-Based Services
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Neurosurgery in the National Capital Region
Neurosurgery Residency Program
Sub-Internship Rotations
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Organ Transplant
Orthopedic Surgery
Osseointegration
Osseointegration FAQs
Otolaryngology
Otolaryngology Resources
Hearing Loss Referral Guidelines
Sleep Apnea Referral Guidelines
Nasal Trauma Referral Guidelines
Neck Mass Referral Guidelines
Otitis Referral Guidelines
Salivary Gland Mass
Sinusitis Referral Guidelines
Thyroid Nodule Referral Guidelines
Tonsils & Adenoid Disease Referral Guidelines
Tympanic Membrane Perforation Referral Guidelines
Facial Plastic & Reconstructive Surgery
Head & Neck Oncology
Referral Guidelines Otolaryngology, Head & Neck Division
Laryngology
Neurotology
Pediatric Otolaryngology
Rhinology
Sleep Medicine
Physical Medicine & Rehabilitation
Plastic Surgery
Project CARE Comprehensive Aesthetic Recovery Effort
Refractive Surgery
Frequently Asked Questions
Trauma Surgery
Vascular Surgery
Urgent & Emergency Care
Emergency Room FAQs
Mental Health
Addiction Treatment
Adult Outpatient Behavioral Health
Behavioral Health Emergency
Child & Adolescent Outpatient Behavioral Health
Social Work & Grief Support
Wellness Network
Medical Equipment & Supplies
Lab Tests & Radiology
Laboratory
Radiation Safety
Radiology
3-D Medical Applications Center
Breast Imaging
Diagnostic Radiology (X-ray, MRI, CT, US, Fluoro, Mammo)
Nuclear Medicine
Radiation Oncology
Radiology Archives
Transplant Immunology Lab
Specialty Care
Allergy, Immunology & Immunization
Amputee Care
Audiology & Speech Pathology
Audiology Clinic
Audiology Volunteer for a Study
Hearing Conservation
Scientific & Clinical Studies Section (SCSS) of the Audiology & Speech Pathology Center (ASC)
Advanced Computational Models of Hearing Loss
Audiology and Speech Pathology Center Current Research Areas
Clinical and Field Studies of Hearing Aid Performance
Development of Auditory Fitness-for-Duty Standards
Evaluation of Advanced Hearing Protection Systems
Multisensory Integration
Recent Staff Publications
Scientific and Clinical Studies Section (SCSS) of the Audiology and Speech Pathology Center (ASC) Collaborators
Scientific and Clinical Studies Section (SCSS) of the Audiology and Speech Pathology Center (ASC) Funding Sources
Scientific and Clinical Studies Section (SCSS) of the Audiology and Speech Pathology Center (ASC) Key Capabilities
Spatial Hearing
Speech, Voice & Swallowing Function
Speech Perception in Noise
Speech Pathology Clinic
Cardiology
Cardiac Catheterization Laboratory
Cardiac CT / Coronary CT Angiography
Cardiovascular Health Assessment, Management, and Prevention
Congenital Cardiology
Chiropractic Clinic
New Patients
Patient Education
Dermatology
Endocrinology, Diabetes & Metabolism
Diabetes Institute
Diabetes Classes
Gastroenterology
Genetics
Geriatrics & Palliative Care
Hearing Conservation
Infectious Diseases
Medical Evaluation & Treatment Clinic (METC)
Murtha Cancer Center
About Murtha Cancer Center
A Letter from the Director
MCC Annual Report
MCC Cancer Reporting Outcomes
MCC Membership
MCC Research & Funding News
Upcoming Events
Advance Care Planning
Appearance Consultation
Breast Care & Research Center
Cancer Genetics
Counseling Services
Dermatologic Oncology/Mohs Surgery
Gynecologic Oncology Service
Hematology Oncology
Orthopaedic Oncology
Benjamin Kyle Potter, MD
Jonathan Agner Forsberg, MD
Palliative Medicine
Pediatric Hematology Oncology
Pediatric Survivorship Clinic
Support Services
Adolescent & Young Adult Program
School Reentry Program
Surgical Oncology
COL (ret) Craig D. Shriver, MD, FACS
LCDR Michele M. Gage, MD, FACS
Col Peter Learn, MD
Radiation Oncology
Urologic Oncology
National Intrepid Center of Excellence (Traumatic Brain Injury Care)
Nephrology
Neurology
Appointment Request
Procedures Instructions
Nuclear Medicine
Nutrition Services
Dining Facility Services
Inpatient Clinical Nutrition Services
Outpatient Clinical Nutrition Services
Occupational Therapy
Orthopedics & Rehabilitation
Pain Management Clinic
Palliative Medicine
Peripheral Nerve Clinic
Physical Therapy
Physical Therapy Home Exercise Videos
Prosthetics & Orthotics
Pulmonary Medicine
Rheumatology
Sleep Clinic
Urology
Case Management
Dental
Dental Clinics
General Dentistry
Hospital Dentistry
Primary Care Dentistry
Oral & Maxillofacial Surgery
Pharmacy
Message Center
Poison Prevention
Q-Anywhere
Storing Medication
Taking Medication
Frequently Asked Questions
Vision
Ophthalmology
Optometry
Refractive Surgery
Frequently Asked Questions
Women's Health & Pregnancy
Breast Imaging Center
Contraceptive Care
Gynecology
Maternal Fetal Medicine
Mother & Infant Care Center
Obstetrics
Pregnancy & Child Birth
Prenatal Assessment Center
Reproductive Endocrinology & Infertility
Urogynecology
Urology
Children's Health
Adolescent & Young Adult Medicine
Armed Forces Center for Child Protection
Children's Hospital-Based Services
Educational and Developmental Intervention Services
Neonatology
Neonatal Intensive Care Unit
Pediatric Primary Care
Pediatric Subspecialties
Developmental and Behavioral Pediatrics
Attention Deficit Hyperactivity Disorder (ADHD)
Healthy Habits
Pediatric, Adolescent & Young Adult Disease Management Service
Pediatric and Adult Congenital Cardiology
Pediatric and Adult General Genetics
Pediatric Endocrinology
Pediatric Gastroenterology
Pediatric Hematology Oncology
Pediatric Infectious Diseases
Pediatric Nephrology
Pediatric Neurology
Pediatric Pulmonology
Pediatric Rheumatology
Basic Information
Diagnosis & Treatment
FAQs - For Parents
FAQs - Information on Specific Diseases
Pediatric Urology
Men's Health
Prostate Center of Excellence
Urology
Readiness
Active Duty Medical/Dental Record
Medical Readiness
Overseas & Suitability Screening
Periodic Health Assessment (PHA)
PHA/Physical Examination Requirements
Operational Deployment Health
Medical Boards
Other
Cancer Center Clinical Trials
Department of Research Programs
Occupational Health
Warrior Care
Warrior Family Coordination Cell (WFCC)
Warrior & Family Coordination Cell: An Overview
Well-Wish Visit, Donation, Event Request Form
Wounded Warrior Pain Care Initiative
Tympanic Membrane Perforation Referral Guidelines
Diagnosis/Definition
A tympanic membrane perforation represents a hole in the eardrum establishing a communication between the middle and external ear.
There are two general types, which are distinguished by the area of the eardrum involved. A central perforation (most common) can involve any portion of the drum as long as a portion of the tympanic membrane surrounds the hole. A marginal perforation involves the edge of the eardrum (tympanic annulus).
A tympanic membrane perforation must be distinguished from a retraction pocket, which is typically an involution of a portion of the intact tympanic membrane and can be a harbinger of cholesteatoma.
Treatment of central and marginal perforations is the same.
Initial Diagnosis and Management
History: Key factors to elicit in the history include the etiology of the perforation, the duration of the perforation, and associated symptoms including hearing loss, otorrhea, vertigo, and tinnitus. Common etiologies include acute or chronic infection, eustachian tube dysfunction, trauma, and previous ear surgery (including PE tube placement). Typically, tympanic membrane perforations heal on their own over the course of 1-4 months, especially if they developed from an acute process. Chronic disease is more likely to require intervention.
Physical: The physical exam should confirm the existence of a perforation vs. a retraction pocket, as well as describe the perforation's size and location. The size is given as a percentage of the drum surface, and the location describes the quadrant of the drum. For example: a 25% central perforation in the anterior inferior quadrant. On pneumotoscopy the TM will not move if there is a perforation. If there is movement, the diagnosis of a TM retraction should be suspected. An examination of the middle ear mucosa should be performed through the perforation to document any pathology (cholesteatoma, infection, etc). Typically with an infection there will be discharge visible in the external ear and the mucosa will look pale and friable. Rinne & Weber tests are always indicated with a 512Hz tuning fork to document hearing loss.
Ancillary Tests: An audiogram should be obtained to document and quantify any hearing loss. This is especially important in the trauma setting as well as in chronic infection.
Initial Management: Management strategies are initially focused on the etiology. Acute and/or chronic infections as well as eustachian tube dysfunction should be treated medically. The majority of tympanic perforations undergo spontaneous closure with conservative care. Patients should be instructed to keep water out of the ear during healing especially during bathing and swimming. Patients may use a large cotton ball saturated with Vaseline (petrolatum) jelly placed onto the outer ear opening to prevent water from entering the ear.
Indications for Specialty Care Referral
An audiogram showing conductive hearing loss associated with a TM perforation.
Traumatic perforation with any of the following: flap of TM into middle ear, vertigo, or hearing loss. Call ENT Clinic and refer immediately.
Recurrent middle ear infections associated with a TM perforation.
Patient desires to participate in water activities AND surgical correction with an otherwise stable perforation without infection or hearing loss.
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