dots. The infectious agent may be viral or bacter-
ial; the doctor is likely to swab the throat to per-
form a rapid strep test to check for streptococci
bacteria. Streptococci tend to migrate to other
parts of the body such as the HEARTvalves, making
any strep infection potentially dangerous. A throat
culture can determine the presence of other path-
ogenic bacteria. Bacterial tonsillitis, including STREP
THROATrequires treatment with ANTIBIOTIC MEDICA-
TIONS. Viral tonsillitis generally runs its course
within two weeks. In either case, ANALGESIC MED-
ICATIONSsuch as acetaminophen or ibuprofen can
provide pain and fever relief.
Children should not receive aspirin for
pain or FEVERbecause of the potential
for REYE’S SYNDROME, a rare but serious
complication.The otolaryngologist may recommend tonsillec-
tomy (an OPERATIONto remove the tonsils) when
recurrent tonsillitis causes the tonsils to remain
enlarged to the extent that they interfere with
BREATHING. Indications of this include loud
snoring when sleeping and mouth breathing
when awake, particularly in children. Enlarged
tonsils can cause OBSTRUCTIVE SLEEP APNEA, in which
there are episodes during sleep when the person
does not breathe. In the normal course of devel-
opment, the tonsils atrophy (shrink) as ADOLES-
CENCE approaches, and by early adulthood
tonsillitis is uncommon. For this reason many
doctors prefer to manage tonsillitis medically
rather than surgically unless ANTIBIOTIC RESISTANCE
develops.
See also EPIGLOTTITIS; LARYNGITIS; OTITIS; PHARYNGI-
TIS; PERITONSILLAR ABSCESS; SINUSITIS; VIRUS.
tympanic membrane A thin piece of tissue that
stretches across the base of the auditory canal (EAR
canal). The tympanic membrane, commonly
called the eardrum, vibrates in response to sound
waves that reach it by traveling from the outer ear
through the auditory canal. The vibrations amplify
the sound waves, which activate the auditory ossi-
cles, tiny bones in the middle ear, to set in motion
the cascade of events that results in NERVEsignals
traveling to the BRAIN.
The tympanic membrane is vulnerable to perfo-
ration, commonly called RUPTURED EARDRUM. Perfo-
ration may occur as a result of injury, such as
penetration of an object or from a sharp blow to
the outer ear, or spontaneously. Fluid accumula-
tion in the middle ear behind the tympanic mem-
brane, usually the consequence of INFECTION, is the
most common cause of spontaneous perforation.
Spontaneous perforation generally heals without
intervention. Traumatic perforation may require
surgical repair (TYMPANOPLASTY).
In addition to amplifying and transferring
sound waves, the tympanic membrane protects
the middle and inner ear from bacteria and debris.
A perforated eardrum exposes the delicate struc-
tures behind it to possible infection and other
damage. Repeated spontaneous perforation due to
chronic OTITISmedia (middle ear infection) can
permanently scar the tympanic membrane,
restricting its ability to vibrate. The otolaryngolo-
gist may insert a small tube through the tympanic
membrane to allow collected fluid to drain
(MYRINGOTOMY) as a preventive measure in chil-
dren who have chronic ear infections.
See also CLEANING THE EAR; FOREIGN OBJECTS IN THE
EAR OR NOSE; HEARING LOSS; MYRINGITIS.tympanoplasty Surgical reconstruction of the
TYMPANIC MEMBRANE (eardrum). Damage to the
tympanic membrane can occur as a result of scar-
ring due to repeated OTITIS media (middle EAR
INFECTION), traumatic injury, and acquired defects
such as might remain following removal of a
CHOLESTEATOMA(pocketlike growth). The otolaryn-
gologist cuts out a small piece of FASCIA(thin con-
nective tissue that covers muscle) from the
temporal MUSCLEat the point of incision behind
the ear when the OPERATIONbegins; this becomes
the new tympanic membrane. Restoration of
hearing varies and may depend on factors not
related to the tympanoplasty. Infection, which
may be present in the middle ear at the time of
the surgery, can cause the new tympanic mem-
brane to fail. About 80 percent of adults who
undergo tympanoplasty experience improvement
in hearing and reduced otitis.
See also MYRINGOTOMY; OTOPLASTY; RHINOPLASTY;
SURGERY BENEFIT AND RISK ASSESSMENT.tympanoplasty 59