Tympanic membrane rupture: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
[[File:Otitis chron mesotymp 4.jpg|thumb]] | [[File:Otitis chron mesotymp 4.jpg|thumb|Smaller perforation]] | ||
[[File:PerforationTympan.jpg|thumb| | [[File:PerforationTympan.jpg|thumb|Larger perforation (acute)]] | ||
[[File:Otitis chron mesotymp 3.jpg|thumb|Larger perforation (chronic)]] | |||
*Ear pain | *Ear pain | ||
*History of barotrauma or direct ear trauma | *History of barotrauma or direct ear trauma | ||
Revision as of 00:51, 16 August 2019
Background
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
- Ear pain
- History of barotrauma or direct ear trauma
Differential Diagnosis
Ear Diagnoses
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
Internal
- Acute otitis media
- Chronic otitis media
- Mastoiditis
Inner/vestibular
Evaluation
- Typically clinical
Management
- Isolated small tympanic membrane perforations
- 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
- In children after TM perforation due to otitis media, PO antibiotics preferred over topical
- Significant hearing loss (≥40 dB), vertigo, nystagmus, ataxia, facial nerve injury, large perforation with folded over edges, prolonged healing
- Urgent evaluation by ENT
Disposition
- Outpatient management