II. Etiology
-
Trauma
- Physical abuse red flag
- Foreign body
- Forceful Ear Irrigation
- Infection
- Middle Ear Barotrauma (e.g. Scuba Injury)
III. Symptoms
IV. Signs
- Size perforation as percent of membrane
- Traumatic perforations often lack discharge
- Weber lateralizes to side of perforation
V. Management
- Keep ear dry
- No swimming
- Ear plugs (or cotton balls in vaseline) for showering or bathing
- Otolaryngology Consultation indications
- Most cases of TM Perforation (but only large,non-healing perforations will need surgery)
- Possible ossicle disruption
- Associated Vertigo (may be due to inner ear injury, consult within 24 hours)
-
Antibiotics (when indicated)
- Indications
- Concurrent Otitis Media
- TM Perforation in a wet, contaminated environment such as seawatere (and also keep canal dry)
- Topical, non-ototoxic Antibiotic options - 100x oral concentration (may also add oral AminopenicillinAntibiotics)
- Do not use Cipro HC Otic (not sterile)
- Avoid all cortisporin products (including suspension, per new labeling as of 2014)
- Combinations with steroid result in faster resolution but are much more expensive
- Ofloxacin 0.3% (Floxin Otic) 5 drops (10 drops if over age 12) twice daily for 7 days
- Ciprofloxacin ophthalmic (ciloxan drops) 4 drops twice daily for 7 days
- Ciprofloxacin 0.3% with Dexamethasone 0.1% (Ciprodex) 4 drops in ear twice daily for 7-10 days
- Ciprofloxacin 0.3% with Fluocinolone Acetonide 0.025% (Otovel) 0.25 ml vial in ear twice daily for 7 days
- Indications
VI. Prognosis
- Usually heal well spontaneously (95% of cases) in 4-6 weeks
- Large or marginal perforations may require surgery
VII. References
- Orman and Finley in Herbert (2018) EM:Rap 18(3):14