A 62 year old female had a daily routine of drying her ears with Q-tips after showering. One day, as she was using the Q-tip in the ear, her phone rang. She answered the phone and placed it to her ear. She felt a sudden pain as the Q-tip was still in her ear and the phone forcefully pushed the Q-tip deep into the ear.
She was seen by her primary care physician and was recommended to see an otologist (ear surgeon). She was examined in our office 2 weeks after the injury and was found to have hearing loss. Pictures of the ear were taken using an ear endoscope (figure 1).
The endoscopic examination revealed significant bruising and a tympanic membrane perforation (hole in eardrum) comprising about 25-30% of the ear drum.
She was given antibiotic drops and was recommended observation, as the full extent of the injury could still not be determined due to copious bruising and inflammation.
She was seen again 4 weeks after initial injury. Exam revealed a larger perforation as the previously bruised areas of the ear drum did not survive. The perforation now measured 50% of the total ear drum surface area. There were also new areas of bruising extending onto the ear canal. (figure 2)
The patient was continued on antibiotic drops to prevent serious infection. She was followed up again at 6 weeks after the initial injury. Endoscopic exam revealed improvement of the bruising, but still a 40% tympanic membrane perforation. (figure 3)
At this point, the patient was counseled and was recommended surgical repair. She understood that spontaneous repair usually occurs around 4-6 weeks, and that her ear drum still had a significant perforation despite observation for over 6 weeks.
Final pre-operative exam revealed a significant conductive hearing loss (audio) and nearly a 50% perforation at 12 weeks post injury. Figure 4. The majority of the previously seen bruising and inflammation had healed, and so timing for surgery was appropriate at this stage.
Surgical Course:
The patient underwent an outpatient procedure with an otologist (ear surgeon) to repair the perforation. A minimally invasive approach was used to access the ear drum (figure 5). With the use of an operating microscope and micro-instruments, the ear canal skin and ear drum were lifted to gain access to the middle ear. (figure 6). A graft was taken from muscle tissue behind the patient’s ear so that it can be flattened and used to reconstruct the missing eardrum. (figure 7). The surgery was uncomplicated and resulted in full coverage of the ear drum perforation. A small packing was placed in the ear canal to keep the graft in place.
The patient had no complications and tolerated the procedure well. She was followed up 2 weeks after surgery for packing removal. Initial evaluation of the ear drum revealed complete closure of the perforation and healing tissue.
The patient was followed up again at 4 weeks post-surgery. The graft appeared to be in place and healing. There was no residual perforation. (Figure 8). Endoscopic exam revealed the presence of small blood vessels running through the graft, indicating that the graft has been accepted by its host tissue.
The patient was seen again at 2 months post-surgery. A hearing test revealed significant improvement in hearing (audio) .
Endoscopic exam demonstrated complete healing of the graft, no residual perforation, and neo-vascularization indicating excellent incorporation of the graft to the host site. (figure 9).
The patient was very pleased with the results.
Discussion:
Q-tip use can lead to serious injury to the ear and may cause infection, pain, vertigo, and even permanent hearing loss.
Upon initial evaluation, antibiotic ear drops are prescribed. Initial observation is usually recommended for about 4 to 6 weeks after injury. This is done to monitor the full extent of the injury and the possibility of spontaneous healing when the injury is minor.
For more major injuries, and when perforations do not close after 6 weeks of observation, surgical correction may be recommended.
Surgery for ear drum perforation repair is an outpatient procedure that can be performed by an otologist (fellowship trained ear surgeon). Initial healing after surgery may take up to 6 to 8 weeks. Most hearing can be regained after successful surgery.
