Tympanic membrane rupture

(Redirected from Perforated TM)

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
    • Ciprofloxacin 0.3% and dexamethasone 0.1% otic suspension - Non-ototoxic; may use if TM is known or suspected to be nonintact, Often used for treatment of mild to moderate disease
  • 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
    • Consider CT temporal bone

Disposition

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

See Also

External Links

References