Tympanic membrane rupture: Difference between revisions
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==Background== | ==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== | ==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== | ==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== | ==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== | ==Disposition== | ||
*Outpatient management | |||
**Complicated or larger perforations require expedited ENT follow up | |||
==See Also== | ==See Also== | ||
*[[Otic barotrauma]] | |||
*[[Ear diagnoses]] | |||
==External Links== | |||
== | ==References== | ||
<references/> | <references/> | ||
[[Category:ENT]] | [[Category:ENT]] | ||
Latest revision as of 05:06, 19 October 2023
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
- 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