Difference between revisions of "Tympanic membrane rupture"

(Management)
(Isolated, Small Perforation)
 
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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 Perforation===
 
===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
  
 
===Isolated, Small Perforation (Pediatric)===
 
===Isolated, Small Perforation (Pediatric)===
*In children after TM perforation due to [[otitis media]], PO [[antibiotics]] preferred over topical
+
*For perforation due to [[otitis media]], PO [[antibiotics]] preferred over topical
  
===Significant or Non-Isolated===
+
===Complicated or Large Perforation===
*Significant [[hearing loss]] (≥40 dB), [[vertigo]], [[nystagmus]], [[ataxia]], [[cranial nerve palsies|facial nerve injury]], large perforation with folded over edges, prolonged healing
+
''See Diagnosis section for definition''
*As above, plus:
+
*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