Davidson B J, Morris M S
Georgetown University School of Medicine, Washington, D.C.
Am Fam Physician. 1992 Apr;45(4):1777-82.
Tympanic membrane perforations typically result from trauma or acute otitis media. Most perforations do not cause more than a mild conductive hearing loss, aural fullness and mild tinnitus. Blood, purulent secretions and other debris should be carefully suctioned out of the canal and the perforation size and location described. Irrigation and pneumatic otoscopy should be avoided. A history of vertigo, nausea and vomiting and an audiogram showing a conductive hearing loss of more than 30 dB suggest disruption of the ossicular chain. Profound sensorineural loss may signify inner ear nerve damage. Mastoid radiographs and computed tomographic scans may be useful in cases of significant trauma and infection. Most small perforations resolve spontaneously. The affected ear should be kept dry. Oral and topical antibiotics may be prescribed for perforations related to acute otitis media. Otolaryngologic referral may be necessary to evaluate traumatic perforations associated with vertigo or significant hearing loss, perforations from chronic otitis media or perforations from acute otitis media that do not heal within one month.
鼓膜穿孔通常由外伤或急性中耳炎引起。大多数穿孔只会导致轻度传导性听力损失、耳闷和轻度耳鸣。应小心地将耳道内的血液、脓性分泌物及其他碎屑吸出，并描述穿孔的大小和位置。应避免冲洗和气动耳镜检查。眩晕、恶心和呕吐病史以及听力图显示传导性听力损失超过30dB提示听骨链中断。严重的感音神经性听力损失可能意味着内耳神经损伤。在严重外伤和感染的情况下，乳突X线片和计算机断层扫描可能有用。大多数小穿孔可自行愈合。患耳应保持干燥。对于与急性中耳炎相关的穿孔，可开具口服和局部用抗生素。对于与眩晕或严重听力损失相关的外伤性穿孔、慢性中耳炎引起的穿孔或急性中耳炎引起的穿孔且在一个月内未愈合的情况，可能需要转诊至耳鼻喉科进行评估。
