Attic Perforation of Tympanic Membrane: Causes and Treatment

Written by Medicover Team and Medically Reviewed by Dr Neha A Padia , ENT

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

Attic perforation of the tympanic membrane is a condition where there is a hole or tear in the eardrum in the upper part of the ear. This perforation can impact health by disrupting the normal functioning of the middle ear and affecting hearing. Sound transmission may be compromised, leading to difficulties in understanding speech and perceiving sound accurately. Additionally, it can increase the risk of ear infections and other complications. Proper management and care are essential to address the challenges associated with Attic perforation of the tympanic membrane and support overall ear health.

What are the Types of Attic Perforation of the Tympanic Membrane?

Attic perforations of the tympanic membrane can vary in their location and size, influencing treatment options and outcomes.

Pars flaccida perforation: A small hole in the upper part of the eardrum caused by chronic middle ear infections or trauma.
Pars tensa perforation: A larger tear in the lower part of the eardrum due to trauma, infection, or barotrauma.
Marginal perforation: A hole at the edge of the eardrum, often resulting from chronic ear infections or trauma.
Central perforation: A hole in the center of the eardrum, commonly caused by infections, trauma, or sudden changes in air pressure.
Attic retraction pocket: An abnormal inward growth of the eardrum, which can lead to recurrent infections and hearing loss.

What Are the Symptoms of Attic Perforation of Tympanic Membrane?

Patients with attic perforation of the tympanic membrane typically experience a range of symptoms related to their ear health.

Symptoms of Attic Perforation of Tympanic Membrane:

Hearing loss
Ear pain
Discharge from the ear
Ringing in the ear (tinnitus)

What Are the Causes of Attic Perforation of Tympanic Membrane?

The primary causes of Attic perforation of the tympanic membrane include chronic ear infections, trauma, and barotrauma from sudden changes in air pressure.

Chronic middle ear infections
Trauma to the ear
Barotrauma (sudden changes in air pressure)
Insertion of foreign objects into the ear canal
Severe earwax buildup
Loud noises or explosions
Complications from ear surgery

When to See a Doctor for Attic Perforation of Tympanic Membrane?

An ENT specialist (Otolaryngologist) should be consulted if you experience persistent ear discharge, hearing loss, or pain. Early evaluation prevents serious complications like cholesteatoma or middle ear infections requiring hospitalization.

You should see a doctor if you have:

Persistent or recurring ear discharge lasting more than a few days, especially if it has an unusual odor or color
Gradual or sudden hearing loss in the affected ear that interferes with daily communication
Recurring earaches, pressure, or fullness in the ear that does not resolve on its own

Get medical help immediately if:

You experience severe ear pain accompanied by high fever, dizziness, or sudden complete hearing loss
There is rapid swelling behind the ear, facial weakness, or signs of spreading infection around the ear area
You develop severe headache, neck stiffness, or confusion, which may indicate the infection has spread beyond the ear

These could be signs of a serious complication like Attic Perforation of Tympanic Membrane, which needs urgent care.

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How is the Diagnosis of Attic Perforation of Tympanic Membrane Done?

Attic perforation of the tympanic membrane is typically diagnosed through a physical examination and evaluation of symptoms by a healthcare provider.

Otoscopy
Tympanometry
Audiometry
High-resolution computed tomography (HRCT)
Magnetic resonance imaging (MRI)

What Are the Treatments for Attic Perforation of the Tympanic Membrane?

Attic perforation of the tympanic membrane is typically managed through various treatment options aimed at promoting healing and preventing complications.

Observation and monitoring: Attic perforations of the tympanic membrane may not always require immediate treatment, especially if they are small and not causing symptoms. Regular monitoring by an ENT specialist is important to assess any changes in the perforation.
Antibiotic ear drops: In cases where there is a risk of infection or if there are signs of infection present, antibiotic ear drops may be prescribed to prevent or treat infection in the middle ear.
Surgical repair (tympanoplasty): For larger or symptomatic attic perforations, surgical repair through tympanoplasty may be recommended. This procedure involves closing the perforation with tissue grafts to restore the integrity of the tympanic membrane.
Myringoplasty: Myringoplasty is a type of surgical procedure specifically focused on repairing perforations in the eardrum, including those in the attic region. This procedure aims to close the hole and improve hearing function.
Pressure equalization tubes (PE tubes): In some cases, especially when there are issues with Eustachian tube function leading to recurrent perforations, PE tubes may be placed in the eardrum to help equalize pressure and prevent future perforations.
This is often considered for cases with chronic ear infections.
It is important to follow the prescribed regimen for optimal effectiveness.

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What Is the Recovery Process for Attic Perforation of the Tympanic Membrane?

Recovery from an attic perforation of the tympanic membrane depends on the size of the perforation, the presence of infection, and the treatment received. Small perforations may heal with appropriate medical care, while larger or persistent perforations often require surgery. Regular follow-up is important to preserve hearing and prevent complications.

Keep the affected ear dry by avoiding water entry during bathing or swimming until the perforation has healed.
Use prescribed antibiotic ear drops or oral medications exactly as directed if an infection is present.
Avoid inserting cotton buds, fingers, or other objects into the ear canal.
Attend regular follow-up visits with an ENT specialist to monitor healing and hearing.
Undergo surgical repair (tympanoplasty) if the perforation does not heal on its own or if a cholesteatoma develops.
Avoid forceful nose blowing and activities that cause sudden pressure changes until your healthcare provider confirms healing.
Seek immediate medical attention if you develop worsening ear pain, persistent ear discharge, hearing loss, dizziness, or fever.

What Are the Risk Factors of Attic Perforation of Tympanic Membrane?

Risk factors for Attic perforation of the tympanic membrane may include repeated ear infections, trauma to the ear, exposure to loud noises, and chronic sinusitis.

Chronic ear infections
Trauma to the ear
Inserting objects into the ear
Barotrauma
Previous ear surgery
Exposure to loud noises
Agerelated changes in the ear

Frequently Asked Questions

1. What causes an attic perforation of the tympanic membrane?

An attic perforation of the tympanic membrane is typically caused by chronic middle ear infections, trauma to the ear, or sudden changes in air pressure.

2. What are the symptoms of an attic perforation of the tympanic membrane?

Symptoms may include hearing loss, ear pain, drainage from the ear, ringing in the ear (tinnitus), and dizziness.

3. How is an attic perforation of the tympanic membrane diagnosed?

Diagnosis is usually made through a physical examination of the ear using an otoscope and may be confirmed with a tympanometry test.

4. Can an attic perforation of the tympanic membrane heal on its own?

Small perforations may heal on their own with proper care and avoidance of further trauma. Larger perforations may require medical intervention.

5. What are the treatment options for an attic perforation of the tympanic membrane?

Treatment options may include observation, antibiotic ear drops, surgical repair (tympanoplasty), or placement of a ventilation tube (tympanostomy tube).