Eardrum Perforation in Children: Treatment Options and Recovery

Inquiry about perforation of the tympanic membrane in children?

Dear Doctor,
My child, who is currently 5 years old, previously underwent adenoidectomy due to respiratory and sleep issues.
About a year and a month after the tympanostomy tube placement, during a follow-up visit, we discovered that one of the tubes had fallen out, with one eardrum having healed and the other still having a perforation.
The doctor advised us to observe for a while.
Yesterday, we returned to the hospital for an examination, and the doctor mentioned that it has been approximately 3 and a half months since the tube fell out, and the likelihood of spontaneous healing is low.
The doctor suggested considering tympanic membrane repair surgery.

I would like to ask if we can continue to observe for natural healing.
Is there a chance for self-healing? If we proceed with the surgery, what is the success rate? Will recovery be immediate after the surgery? Thank you for your response.

A Yong, 30~39 year old female. Ask Date: 2021/05/14

Dr. Li Jiaxuan reply Otolaryngology

Generally, if there are no chronic diseases, healing typically occurs within three months.
However, if there is already scarring around the perforation of the eardrum, the chances of healing are low, and the physician may recommend surgery.
If you prefer to postpone surgery for now, that is an option, but it may not be suitable for young children to swim.
After bathing, be sure to dry the inside of the ear.
Wishing you safety and health.

Reply Date: 2021/05/14

More Info

Eardrum perforation, or tympanic membrane perforation, is a condition that can occur in children due to various reasons, including infections, trauma, or complications from ear surgeries. In your case, it seems that your child has experienced a perforation following the placement of ventilation tubes (tympanostomy tubes) and subsequent loss of one of those tubes.

Treatment Options
1. Observation: In some cases, especially if the perforation is small and the child is asymptomatic, doctors may recommend a period of observation. The eardrum has the potential to heal on its own, particularly in younger children. However, as your doctor mentioned, if the perforation has persisted for several months without signs of healing, the likelihood of spontaneous closure diminishes.

2. Eardrum Repair Surgery (Tympanoplasty): If the perforation does not heal on its own, surgical intervention may be necessary. Tympanoplasty is a procedure that involves repairing the eardrum, which can restore hearing and prevent recurrent ear infections. The success rate for tympanoplasty is generally high, often reported between 80% to 90%, depending on various factors such as the size of the perforation, the presence of any underlying ear disease, and the overall health of the child.

Recovery and Success Rates
- Self-Healing: While there is a chance for the eardrum to heal on its own, this is less likely if the perforation has been present for an extended period, as in your child's case. Factors such as the size of the perforation and the child's overall health can influence healing.
- Surgical Success: If surgery is performed, the recovery process typically involves a few weeks of rest and avoiding water in the ear. Most children can return to normal activities relatively quickly, but complete healing of the eardrum may take several weeks to months. Post-operative care is crucial to ensure the best outcome, including follow-up visits to monitor healing.

- Hearing Restoration: After successful surgery, many children experience significant improvement in hearing. However, the extent of recovery can vary based on the initial condition of the ear and any other underlying issues.

Conclusion
In conclusion, while observation is an option, the likelihood of spontaneous healing decreases with time. If your child's perforation has not shown signs of healing after several months, discussing the possibility of tympanoplasty with your healthcare provider is advisable. The procedure has a high success rate and can significantly improve your child's quality of life by restoring hearing and reducing the risk of future ear infections. Always ensure to follow up with your ENT specialist for personalized advice and to discuss the best course of action for your child's specific situation.

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