Difference between revisions of "Tympanic membrane rupture"

m (Rossdonaldson1 moved page Tympanic Membrane Rupture to Tympanic membrane rupture)
(Isolated, Small Perforation)
 
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==Background==
 
==Background==
*Blunt trauma (hand blow to ear, fall, direct hit)
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[[File:Gray907.png|thumb|Ear anatomy]]
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===Causes===
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*[[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  
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*[[Lightning]] strike
**Blast injury
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*[[Barotrauma]]
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**[[Blast injury]]
 
**Air travel
 
**Air travel
 
**[[Diving Emergencies|Scuba diving]]
 
**[[Diving Emergencies|Scuba diving]]
  
 
==Clinical Features==
 
==Clinical Features==
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[[File:Otitis chron mesotymp 4.jpg|thumb|Smaller perforation]]
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[[File:PerforationTympan.jpg|thumb|Larger perforation (acute)]]
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[[File:Otitis chron mesotymp 3.jpg|thumb|Larger perforation (chronic)]]
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*[[earache|Ear pain]]
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*History of barotrauma or direct ear trauma
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*May also have:
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**[[hearing loss]]
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**[[Vertigo]]
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**[[Nystagmus]]
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**[[Ataxia]]
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**[[Cranial nerve palsies|Facial nerve injury]]
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
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{{Ear DDX}}
  
==Workup==
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==Evaluation==
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*Typically clinical
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===Diagnosis===
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Definition of "complicated or large perforation" (see management):
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*Significant [[hearing loss]] (≥40 dB)
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*[[Vertigo]]
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*[[Nystagmus]]
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*[[Ataxia]]
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*[[Cranial nerve palsies|facial nerve injury]]
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*Large perforation with folded over edges
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*Prolonged healing
  
 
==Management==
 
==Management==
*Isolated small tympanic membrane perforations
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===Isolated, Small Perforation===
**Antibiotic ear drops for contaminated wounds
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**Antibiotic ear drops for contaminated wounds - [[Ofloxacin]] is safe for perforation
**Water precautions (keeping water out of the middle ear)
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**Don't give [[Ciprofloxacin]] can damage the inner ear
**Reevaluation  
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**Water precautions (keeping water out of the middle ear), avoid forceful Valsalva
*Significant hearing loss (≥40 dB), vertigo, nystagmus, ataxia, or facial nerve injury
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**Reevaluation with PCM, typical healing within 4-6 weeks
 +
 
 +
===Isolated, Small Perforation (Pediatric)===
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*For perforation due to [[otitis media]], PO [[antibiotics]] preferred over topical
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 +
===Complicated or Large Perforation===
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''See Diagnosis section for definition''
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*As for simple perforations (see above), plus:
 
**Urgent evaluation by ENT
 
**Urgent evaluation by ENT
  
 
==Disposition==
 
==Disposition==
 +
*Outpatient management
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**Complicated or larger perforations require expedited ENT follow up
  
 
==See Also==
 
==See Also==
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*[[Otic barotrauma]]
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*[[Ear diagnoses]]
  
==Sources==
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==References==
 
<references/>
 
<references/>
  
 
[[Category:ENT]]
 
[[Category:ENT]]

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