Tympanic membrane rupture
Background
Ear anatomy
Causes
- Blunt trauma (hand blow to ear, fall, direct hit)
- Penetrating trauma (Q-tip, matchstick, gunshot wound, welding spark)
- Direct ear trauma
- Lightning strike
- Barotrauma
- Blast injury
- Air travel
- Scuba diving
Clinical Features
Smaller perforation
Larger perforation (acute)
Larger perforation (chronic)
- Ear pain
- History of barotrauma or direct ear trauma
- May also have:
- hearing loss
- Vertigo
- Nystagmus
- Ataxia
- Facial nerve injury
Differential Diagnosis
External
- Auricular hematoma
- Auricular perichondritis
- Cholesteatoma
- Contact dermatitis
- Ear foreign body
- Herpes zoster oticus (Ramsay Hunt syndrome)
- Malignant otitis externa
- Otitis externa
- Otomycosis
- Tympanic membrane rupture
Inner/vestibular
- Labyrinthitis, vestibular neuritis
- Meniere's disease
- Sudden sensorineural hearing loss
Evaluation
- Typically clinical
Diagnosis
Definition of "complicated or large perforation" (see management):
- Significant hearing loss (≥40 dB)
- Vertigo
- Nystagmus
- Ataxia
- facial nerve injury
- Large perforation with folded over edges
- Prolonged healing
Management
Isolated, Small Perforation
- Antibiotic ear drops for contaminated wounds - ciprofloxacin suspension (more appropriately viscous than solution)
- Water precautions (keeping water out of the middle ear), avoid forceful Valsalva
- Reevaluation with PCM, typical healing within 4-6 weeks
Isolated, Small Perforation (Pediatric)
- For perforation due to otitis media, PO antibiotics preferred over topical
Complicated or Large Perforation
See Diagnosis section for definition
- As for simple perforations (see above), plus:
- Urgent evaluation by ENT
Disposition
- Outpatient management
- Complicated or larger perforations require expedited ENT follow up
See Also
References
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