Tympanic membrane rupture: Difference between revisions
| Line 51: | Line 51: | ||
===Complicated or Large Perforation=== | ===Complicated or Large Perforation=== | ||
''See Diagnosis section for definition'' | ''See Diagnosis section for definition'' | ||
*As above, plus: | *As for simple perforations (see above), plus: | ||
**Urgent evaluation by ENT | **Urgent evaluation by ENT | ||
Revision as of 17:10, 2 July 2020
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
- May also have:
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
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