No conflicts of interest were identified by the planning committee, faculty, authors and reviewers for this program.

Transcription

1 Disclosure: Is that a Hole? Evaluation and Treatment of TM Perforations Kristi McGowin, MSN, CPNP Children s Mercy Hospital Kansas City, MO No conflicts of interest were identified by the planning committee, faculty, authors and reviewers for this program. 2 Outline Ear Anatomy Identify Ear Anatomy Discuss causes of tympanic membrane perforations Discuss management of perforations Discuss hearing evaluation Discuss TM perf repairs 3 4 1

2 Causes of Perforations 7 Acute Otitis Media Trauma 9 10 Foreign body Tube placement

3 TM Perforations Management of Perforations Monitor size and location of perf Evaluate margins of perf cholesteatoma Follow audiogram Stress water precautions Cholesteatoma Squamous epithelium (skin) in middle ear or mastoid Congenital and Acquired Primary acquired Secondary acquired Conductive Hearing Loss and Otorrhea Treatment: +/- Mastoidectomy (Second Stage) Ossiculoplasty 15 Follow audiogram Normal Hearing Mild (Hearing Loss) Moderate Moderately Severe Severe Profound 0-25 db db db db db > 90 db 17 3

4 Water Precautions Perf Repairs KEEP EAR DRY 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 Perf Repairs Fat Graft Myringoplasty 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 Graft can be fat, cartilage or fascia Fascia is most common Cartilage 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 23 4

5 Fascia Transcanal approach No incision Postauricular approach Post auricular incision Medial/underlay Lateral/overlay : Medial Graft (Underlay) and Mastoidectomy and Mastoidectomy 30 5

6 Case Study Case 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? 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? Children s Mercy Kansas City Children s Mercy ENT Together We re Working Wonders QUESTIONS???

7 Contact Information Kristi McGowin, MSN, CPNP Office: References Bluestone, C., Stool, S., Alper, C., Arjamand, E., Casselbrant, M., Dohar, J., Yellon,R. (2005). Pediatric Otolaryngology, 4 th 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