Microperforation of the pars tensa caused by a hair.

The accompanying otoscopic view is that of a right ear with a pinpoint perforation of the pars tensa that occurred when a hair grew against the tympanic membrane. A patch of white tympanosclerosis occupies the posterior, superior quadrant of the pars tensa. Tympanosclerosis in the posterior, superior quadrant of the pars tensa is also evident. The pars tensa otherwise appears to be intact and normal. Halfway between the umbo and the annulus, in line with the handle of the malleus, a pinpoint perforation can be seen through the pars tensa. It is dry and exhibits no evidence of infection. A dark hair is seen growing from the anterior external auditory canal and extending through the perforation of the pars tensa.

Hair growing against the tympanic membrane can occasionally (usually every 4 or 5 years) produce an annoying tinnitus. Simple removal of the hair will solve the problem, until it again grows against the tympanic membrane. On rare occasions, the hair will cause a perforation. In such a situation, the hair must be removed. A minor repair of the perforation, usually by excising the edges of the perforation under local anesthesia in the office and covering it with a patch, is satisfactory treatment.

From private practice (retired), Gap, France (Dr. Deguine) and the Pulec Ear Clinic, Los Angeles (Dr. Pulec).