hi everybody this is Rhys barber from
audiology associates thank you very much
for watching video today we thought we
put on an exploration video for
perforated eardrums because we had so
many comments asking very similar
questions for the video we put on
earlier today which show the perforation
we thought it would be easier to just do
an explanation but you always should
answer most of your questions because a
few people had a few different queries
so the first thing we'll do is show you
the difference between healthy and
perforated eardrums now when we do an
examination so when we do some itas
could be looking in the ears what we're
looking for is a few key features on the
eardrum so if we look at the healthy air
drum here first of all the first thing
we're going to look for is can we see
some smooth healthy skin does it look
the right colour is it smooth
pearlescent shiny which is exactly what
this is here and then we're gonna look
for some other key features we're going
to look for a hammer bone which is this
section here just sitting behind the
edge and just protruding through ever so
slightly and we're also going to be
looking for this is what we call light
reflex now in most cases and the light
reflex will normally what they call a
cone of light which will be more this
kind of shape so this is the sort of
reflection you get back well that's the
shape of the reflection if the eardrum
isn't sitting quite an intern or --ml
position and what you'll get then is
this more diffuse looking's of a light
reflex so basically this is the light
from from in our case the endoscope it
was shiny and shining back at us now
what we don't want to see is what we can
see here on the right hand side which is
a large hole here in the center so you
can see we're missing some of those key
features so the first thing is the
hammer bone should be running in this
direction yeah so we can't see that
patrolling through there the skin of the
eardrum looks quite thickened and
toughened up so not the translucent kind
of skin we can see here and we've also
got a great big hole right in the middle
of the the eardrum there now what you
can see through this hole is actually
the middle ear space back here so this
is where the three little bones of the
middle ear are found in this section it
looks a little bit shiny so a little bit
wet in there but that's quite normal for
the middle ear space now people asking
why do we get perforations what the most
common causes how does this happen is it
painful that was another question we
were getting asked a lot so the main
cause
of things that perforation to the
eardrums are usually trauma or infection
so by trauma I mean someone's popped
something into the ryokan in a bit too
far and actually punch of the eardrum
and by infection you can get infections
in the outer ear which is from the
eardrum out and you can also get
infections of the middle ear space which
is back here so sometimes if you get
infections in the middle ear space what
happens is the infection builds and
builds and builds put lots of pressure
on ear drum and eventually the usual
more bursts to release that pressure you
can get perforations from things like if
you went scuba diving so big pressure
changes or big air pressure changes some
people get it when flying but that's
more raised usually followed by some
other conditions as well so those are
the main kind of issues as to why you
get a perforation is it painful well
some people don't realize they've had a
perforation because if you were talking
about say a middle ear infection the
pressure building behind eardrum can be
really uncomfortable anyway so when the
perforation happens when the interim
releases that infection and releases the
pressure then people find out a relief
so they may not necessarily know they've
got a perforation to the eardrum
obviously if you've had trauma if you if
you push something in there then
obviously you know it's going to be
really uncomfortable as far as whether
perforations are uncomfortable generally
northern art unless they're causing
problems with infection or they're
discharging all the time in which case
you might get a little bit of itching
then you probably wouldn't notice it
wouldn't be a painful experience style
perforation people have asked would this
reduce hearing yes it would most
perforations if they're large enough
will have an impact on hearing so it
will reduce the hearing slightly if it's
a very small perforation what they call
a pinhole perforations are much much
smaller you'll be looking at something
maybe kind of you know RT ds1 with this
kind of size then know your chances I
wouldn't really affect the hearing that
much treatment lots of people asking
well what do you do with perforations
the simple answer is leave them well
alone in the most cases because the
eardrum is very clever it will try to
repair itself so what normally happens
is the skin grows into the space from
oh so it just starts to close the gap up
and in most cases that does it really
affected me now if you've got quite a
large perforation this is quite large
this one it's not subtotal which means
it's not not the majority of the
eardrums gone so but it is a pretty
large eardrum what you may find is as
the skin starts to grow into the center
it can't support itself so it collapses
down so you always end up with another
hole which then grows back out to the
space of this there so some of these
perforations won't heal up in that case
then if the perforation is well behaved
and it's not being causing any
infections or not causing tremendous
amount of hearing loss the consultant
would probably leave it well alone if
it's causing lots of problems like
infection or if it is quite considerable
hearing loss there then what they can do
is rebuild the eardrum which is what I
call it tympanoplasty so what they're
doing effectively is patching over this
unsealing it over but then the skin is
neveress thin as a normal ear drum skin
and you will sometimes get still get a
residual hearing loss with that as well
so the majority of times we just leave
these well alone and don't play around
with them you would need to keep this
ear nice and dry because any water
getting into that year canal would also
end up in the middle ear space which is
in here now this is a perfect breeding
ground for infection because it's now
open any water any bacteria getting in
there he's going to multiply you can get
infections you get a Weeping from the
year of pitching in the year those kind
of things coming through now
interestingly what happened with our
patient that you saw in the video
earlier was instead of the skin growing
into the center it had started growing
away from the eardrum and down into the
ear canal which is here so what we end up
with then is a long tube like this of
skin and what we do is we remove that to
try and encourage this skin then to try
and do its normal process which is to
grow back into the center like that now
we can't promises that's going to happen
we just don't know but hopefully that
will happen for this gentleman and that
will start to to go through and patch
itself back up again it was anything
last really but yeah lots of lots of
questions came out there if
missed the question I apologize as you
try and give a general overview but
obviously if you if you have any more
questions then just pop them into the
comment if you enjoy this kind of video
and you enjoyed the fact that we do
these two exploration videos we'd like
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want to do okay guys I hope that's
answered most your questions for you
have a great evening and as always take
care