- Most tympanic membrane perforations (TMPs) are diagnosed using routine otoscopy
- Small perforations may require otomicroscopy for identification
- Some hearing screening programs include middle ear impedance testing
- Screening tympanometry may reveal abnormalities consistent with perforation. Confirmation still requires examination
- Always perform audiometry upon initial TMP diagnosis and again before any repair attempt, whether in the office or in the operating room
- Preoperative and postoperative audiography should always be performed. A major conductive loss not only alerts the surgeon to the possible existence of ossicular lesions, but documentation of a preexisting sensorineural hearing loss may protect the surgeon from later allegations that the surgery caused the hearing loss
- Audiometry often reveals normal hearing. The presence of mild conductive hearing loss is consistent with perforation, and a conductive component of at least 30 dB indicates possible ossicular discontinuity or a pathologic condition
In rare cases, otomicroscopy and impedance studies still leave the TMP diagnosis questionable. To provide evidence of perforation (in the form of a stream of bubbles), fill the ear canal with sufficient distilled water or sterile saline to cover the tympanic membrane and have the patient perform the Valsalva maneuver. A negative test result is suggestive but not definitive. A positive test result is caused only by TMP.
In chronic TMP, squamous epithelium is found adjacent to middle ear mucosa and creates a perforation edge with no raw surface. Such healing of the perforation edge is undoubtedly a contributing factor to perforation persistence.
Dizziness and Motion Sickness
Your physician will examine your ears, nose, and throat and do tests of nerve and balance function. Because the inner ear controls both balance and hearing, disorders of balance often affect hearing and vice versa. Therefore, your physician will probably recommend hearing tests (audiograms). The physician might order skull X rays, a CT or MRI scan of your head, or special tests of eye motion after warm or cold water is used to stimulate the inner ear (ENG – electronystagmography). In some cases, blood tests or a cardiology (heart) evaluation might be recommended.
Not every patient will require every test. The physician’s judgment will be based on each particular patient. Similarly, the treatments recommended by your physician will depend on the diagnosis.
The benefits received from hearing aids can differ significantly from person to person. Your success will largely depend on your motivation and willingness to work at improving your hearing.
Most people need an adjustment period–usually lasting from a few days to a few weeks–to experiment with various sound levels and various types of background noise before their amplified hearing becomes second nature. It is also common for your instruments to require minor adjustments from the laboratory when they are new. Experience has shown that with proper counseling and practice, most hearing losses can be successfully fit with hearing aids.
Recent advances in micro-technology have greatly improved the performance of today’s hearing aids. New circuit options improve comfort and clarity in difficult listening situations and also allow the tailoring of instruments to match specific hearing needs.
It’s no secret that today’s hearing instruments look great! What’s more impressive is that today’s models also sound, feel and perform better than ever. The three types of hearing aid technologies available today are analog, programmable, and digital. Your audiologist can advise you which of the many models and/or circuit options would be best for your hearing needs.