Difference between revisions of "Tympanic membrane rupture"

(Background)
(Isolated, Small Perforation)
 
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[[File:Gray907.png|thumb|Ear anatomy]]
 
[[File:Gray907.png|thumb|Ear anatomy]]
 
===Causes===
 
===Causes===
*Blunt trauma (hand blow to ear, fall, direct hit)
+
*[[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
*Lightning strike
+
*[[Lightning]] strike
*Barotrauma  
+
*[[Barotrauma]]
**Blast injury
+
**[[Blast injury]]
 
**Air travel
 
**Air travel
 
**[[Diving Emergencies|Scuba diving]]
 
**[[Diving Emergencies|Scuba diving]]
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[[File:PerforationTympan.jpg|thumb|Larger perforation (acute)]]
 
[[File:PerforationTympan.jpg|thumb|Larger perforation (acute)]]
 
[[File:Otitis chron mesotymp 3.jpg|thumb|Larger perforation (chronic)]]
 
[[File:Otitis chron mesotymp 3.jpg|thumb|Larger perforation (chronic)]]
*Ear pain
+
*[[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==
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==Evaluation==
 
==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 - [[ciprofloxacin]] suspension (more appropriately viscous than solution)
+
**Antibiotic ear drops for contaminated wounds - [[Ofloxacin]] is safe for perforation
 +
**Don't give [[Ciprofloxacin]] can damage the inner ear
 
**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
*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
+
===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==

Latest revision as of 17:44, 17 August 2021

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 - Ofloxacin is safe for perforation
    • Don't give Ciprofloxacin can damage the inner ear
    • 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