View source for Tympanic membrane rupture

==Background==
[[File:Gray907.png|thumb|Ear anatomy]]
===Causes===
*[[blunt head trauma|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
**[[Diving Emergencies|Scuba diving]]

==Clinical Features==
[[File:Otitis chron mesotymp 4.jpg|thumb|Smaller perforation]]
[[File:PerforationTympan.jpg|thumb|Larger perforation (acute)]]
[[File:Otitis chron mesotymp 3.jpg|thumb|Larger perforation (chronic)]]
*[[earache|Ear pain]]
*History of barotrauma or direct ear trauma
*May also have:
**[[hearing loss]] 
**[[Vertigo]]
**[[Nystagmus]]
**[[Ataxia]]
**[[Cranial nerve palsies|Facial nerve injury]]

==Differential Diagnosis==
{{Ear DDX}}

==Evaluation==
*Typically clinical

===Diagnosis===
Definition of "complicated or large perforation" (see management):
*Significant [[hearing loss]] (≥40 dB)
*[[Vertigo]]
*[[Nystagmus]]
*[[Ataxia]]
*[[Cranial nerve palsies|Facial nerve injury]]
*Large perforation with folded over edges
*Prolonged healing

==Management==
===Isolated, Small Perforation===
*Antibiotic ear drops for contaminated wounds
**[[Ofloxacin]] is safe for perforation
**Ciprofloxacin 0.3% and dexamethasone 0.1% otic suspension - Non-ototoxic; may use if TM is known or suspected to be nonintact, Often used for treatment of mild to moderate disease
*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
**Consider CT temporal bone

==Disposition==
*Outpatient management
**Complicated or larger perforations require expedited ENT follow up

==See Also==
*[[Otic barotrauma]]
*[[Ear diagnoses]]

==External Links==

==References==
<references/>

[[Category:ENT]]