Tympanic membrane rupture: Difference between revisions
ClaireLewis (talk | contribs) No edit summary |
|||
| Line 31: | Line 31: | ||
==Management== | ==Management== | ||
===Isolated, Small Perforation=== | |||
**Antibiotic ear drops for contaminated wounds - [[ciprofloxacin]] suspension (more appropriately viscous than solution) | **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 | **Water precautions (keeping water out of the middle ear), avoid forceful Valsalva | ||
**Reevaluation with PCM, typical healing within 4-6 weeks | **Reevaluation with PCM, typical healing within 4-6 weeks | ||
===Isolated, Small Perforation (Pediatric)=== | |||
*In children after TM perforation due to [[otitis media]], PO [[antibiotics]] preferred over topical | *In children after TM perforation due to [[otitis media]], PO [[antibiotics]] preferred over topical | ||
===Significant or Non-Isolated=== | |||
*Significant [[hearing loss]] (≥40 dB), [[vertigo]], [[nystagmus]], [[ataxia]], [[cranial nerve palsies|facial nerve injury]], large perforation with folded over edges, prolonged healing | *Significant [[hearing loss]] (≥40 dB), [[vertigo]], [[nystagmus]], [[ataxia]], [[cranial nerve palsies|facial nerve injury]], large perforation with folded over edges, prolonged healing | ||
*As above, plus: | |||
**Urgent evaluation by ENT | **Urgent evaluation by ENT | ||
Revision as of 17:05, 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
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)
- In children after TM perforation due to otitis media, PO antibiotics preferred over topical
Significant or Non-Isolated
- Significant hearing loss (≥40 dB), vertigo, nystagmus, ataxia, facial nerve injury, large perforation with folded over edges, prolonged healing
- As above, plus:
- Urgent evaluation by ENT
Disposition
- Outpatient management