Tympanic membrane rupture: Difference between revisions

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==Background==
==Background==
*Blunt trauma (hand blow to ear, fall, direct hit)
[[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)  
*Penetrating trauma (Q-tip, matchstick, gunshot wound, welding spark)  
*Direct ear trauma
*Direct ear trauma
*Barotrauma  
*[[Lightning]] strike
**Blast injury
*[[Barotrauma]]
**[[Blast injury]]
**Air travel
**Air travel
**[[Diving Emergencies|Scuba diving]]
**[[Diving Emergencies|Scuba diving]]


==Clinical Features==
==Clinical Features==
[[File:PerforationTympan.jpg|thumb|Perforated TM]]
[[File:Otitis chron mesotymp 4.jpg|thumb|Smaller perforation]]
*Ear pain
[[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
*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}}
{{Ear DDX}}


==Diagnosis==
==Evaluation==
*Typically clinical
*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 tympanic membrane perforations
===Isolated, Small Perforation===
**Antibiotic ear drops for contaminated wounds
**Antibiotic ear drops for contaminated wounds - [[ciprofloxacin]] suspension (more appropriately viscous than solution)
**Water precautions (keeping water out of the middle ear)
**Water precautions (keeping water out of the middle ear), avoid forceful Valsalva
**Reevaluation  
**Reevaluation with PCM, typical healing within 4-6 weeks
*Significant hearing loss (≥40 dB), vertigo, nystagmus, ataxia, or facial nerve injury
 
===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
**Urgent evaluation by ENT


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


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


==References==
==References==

Revision as of 17:10, 2 July 2020

Background

Ear anatomy

Causes

Clinical Features

Smaller perforation
Larger perforation (acute)
Larger perforation (chronic)

Differential Diagnosis

Ear Diagnoses

External

Internal

Inner/vestibular

Evaluation

  • Typically clinical

Diagnosis

Definition of "complicated or large perforation" (see management):

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)

Complicated or Large Perforation

See Diagnosis section for definition

  • As for simple perforations (see above), plus:
    • Urgent evaluation by ENT

Disposition

  • Outpatient management
    • Complicated or larger perforations require expedited ENT follow up

See Also

References