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Kristi McGowin, MSN, CPNP
Children’s Mercy Hospital
Kansas City, MO
Is that a Hole? Evaluation and Is that a Hole? Evaluation and Treatment of TM PerforationsTreatment of TM Perforations
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Disclosure:Disclosure:
No conflicts of interest were identified by the planning committee, faculty, authors and reviewers for this program.
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OutlineOutline
• Identify Ear Anatomy
• Discuss causes of tympanic membrane
perforations
• Discuss management of perforations
• Discuss hearing evaluation
• Discuss TM perf repairs
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Ear AnatomyEar Anatomy
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Causes of Perforations
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• Acute Otitis Media
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• Trauma
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• Foreign body
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• Tube placement
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TM PerforationsTM Perforations
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Management of PerforationsManagement of Perforations
• Monitor size and location of perf
• Evaluate margins of perf
– cholesteatoma
• Follow audiogram
• Stress water precautions
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CholesteatomaCholesteatoma� Squamous epithelium (skin) in
middle ear or mastoid
� Congenital and Acquired
� Primary acquired
� Secondary acquired
� Conductive Hearing Loss and
Otorrhea
� Treatment:
� Tympanoplasty +/-
Mastoidectomy
� (Second Stage)
Ossiculoplasty
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Follow audiogramFollow audiogram
Normal Hearing 0-25 dB
Mild (Hearing Loss) 26-40 dB
Moderate 41-55 dB
Moderately Severe 56-70 dB
Severe 71-90 dB
Profound > 90 dB
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Water PrecautionsWater Precautions
• KEEP EAR DRY
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PerfPerf RepairsRepairs
• Paper Patch Myringoplasty
– Can be done in clinic on some patients
– Usually OR procedure (especially in kids)
– Keep ear dry for 4 weeks post op
– Follow up in 4-6 weeks to evaluate closure
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PerfPerf RepairsRepairs
• Fat Graft Myringoplasty
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TympanoplastyTympanoplasty
• Reconstruction of the eardrum and/or the
small bones (ossicles) of the middle ear.
• A graft is used to repair or replace the ear
drum.
• Can also be to explore the middle ear
space
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TympanoplastyTympanoplasty• Graft can be fat, cartilage or fascia
• Fascia is most common
• Graft is harvested from another area,
behind the ear or thigh (typically).
• Packing is used in the middle ear and
external ear canal to keep graft in place.
• Can be done with or without
mastoidectomy©2013 Children's Mercy Hospitals and Clinics. All Rights Reserved. 03/13
Cartilage
Tympanoplasty
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Fascia Fascia TympanoplastyTympanoplasty
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TympanoplastyTympanoplasty
• Transcanal approach
– No incision
• Postauricular approach
– Post auricular incision
• Medial/underlay
• Lateral/overlay
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Tympanoplasty: Medial
Graft (Underlay)
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Tympanoplasty and
Mastoidectomy
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Tympanoplasty and
Mastoidectomy
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TympanoplastyTympanoplasty
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Case StudyCase Study
• 9 year old female with history of traumatic
perforation of the left ear a year ago.
Exam reveals a large central perf.
Audiogram notes a moderate left
conductive hearing loss.
• What else do we need to know?
• What is our plan?
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Case StudyCase Study
• 6 year old female with history of bilateral
myringotomy at 2 years of age. Right TM
with small central perf. Audiogram is
normal.
• What else do we need to know?
• What is our plan?
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Children’s Mercy Kansas CityChildren’s Mercy Kansas City
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Children’s Mercy ENTChildren’s Mercy ENT
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Together We’re Together We’re Working WondersWorking Wonders
www.childrensmercy.org
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QUESTIONS???
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Contact InformationContact Information
• Kristi McGowin, MSN, CPNP
• Office: 816-234-6297
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ReferencesReferences
• Bluestone, C., Stool, S., Alper, C., Arjamand, E., Casselbrant, M., Dohar, J., Yellon,R.
(2005). Pediatric Otolaryngology, 4th Edition. Saunders: Philadelphia.
• Bluestone, C., Stool, S. (2004). Atlas of Pediatric Otolaryngology. Saunders:
Philadelphia.
• Sanna, M., Russo, A., De Donato, G., Caruso, A., & Taibah, A. (2002). Color Atlas of
Otoscopy. Thieme Verlag: Germany.