Otolaryngology Book


Tympanic Membrane Perforation

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

Tympanic Membrane Perforation (C0206504)

Definition (MSHCZE) Dočasný nebo trvalý otvor v ušním bubínku (MEMBRANA TYMPANI). Klinické příznaky závisejí na velikosti, umístění a dalších patologických okolnostech.
Definition (MSH) A temporary or persistent opening in the eardrum (TYMPANIC MEMBRANE). Clinical signs depend on the size, location, and associated pathological condition.
Concepts Injury or Poisoning (T037)
MSH D018058
ICD9 384.20, 384.2
ICD10 H72, H72.9, H72.90
SnomedCT 60442001, 194314003, 155243007, 194319008, 271743003
English Tympanic Membrane Rupture, Tympanic Membrane Perforation, Membrane Perforation, Tympanic, Membrane Rupture, Tympanic, EAR DRUM PERFORATION, Rupture, Tympanic Membrane, TYMPANIC MEMBRANE PERFORATION, Ear drum perforation, Perforation of tympanic membrane, unspecified, Tympanic membrane perf. NOS, Tympanic membrane perf.unspec., Tympanic membrane perforation, Tympanic membrane perforation NOS, Unspecified tympanic membrane perforation, Perforation, Eardrum, Eardrum Perforation, tympanic membrane perforated (___ mm), perforated eardrum, perforated tympanic membrane (diagnosis), perforated tympanic membrane, perforated tympanic membrane (physical finding), tympanic membrane perforation, Perforat tympan memb NOS, Unspecified perforation of tympanic membrane, unspecified ear, Unspecified perforation of tympanic membrane, Tympanic Membrane Perforation [Disease/Finding], eardrum ruptures, Perforation;ear drum, drum ear ruptured, perforation of ear drum, tympanic membrane rupture, eardrum perforation, eardrums perforated, drums ear rupturing, ear drum ruptured, perforation ear drum, rupture eardrum, ruptured ear drum, drums ear ruptured, eardrum perforated, eardrum rupture, drum ear perforation, ear drum perforation, membrane rupture tympanic, perforation of eardrum, Unsp perforation of tympanic membrane, unspecified ear, Perforation tympanic membrane, Unspecified tympanic membrane perforation (disorder), Tympanic membrane perforation NOS (disorder), Tympanic membrane perforation (disorder), Rupture of ear drum, Rupture of tympanic membrane, Perforation of tympanic membrane, Perforation of ear drum, Tear of tympanic membrane, Perforated eardrum, Perforation of eardrum, Perforation of tympanic membrane (disorder), Tear of tympanic membrane (finding), Perforation ear drum, ear drum; rupture, membrana tympani; rupture, perforation; tympanum, rupture; ear drum, rupture; tympanic membrane, tympanic membrane; rupture, tympanum; perforation, Perforation of ear drum, NOS, Perforation of tympanic membrane, NOS, Perforation of ear drum NOS, Perforation;tympanic membran, perforation of the ear Drums, perforation of the tympanic membrane
German TROMMELFELLPERFORATION, Perforation des Trommelfells, unspezifisch, Perforation des Trommelfells, perforiertes Trommelfell, TROMMELFELLVERLETZUNG, Trommelfellperforation, nicht naeher bezeichnet, Perforation des Trommelfelds, Trommelfellperforation, Trommelfellruptur
Dutch perforatie van trommelvlies, geperforeerd trommelvlies, niet-gespecificeerde trommelvliesperforatie, Perforatie trommelvlies, membrana tympani; ruptuur, perforatie; trommelvlies, ruptuur; membrana tympani, ruptuur; trommelvlies, trommelvlies; perforatie, trommelvlies; ruptuur, Perforatie van trommelvlies, niet gespecificeerd, trommelvliesperforatie, Perforatie van trommelvlies, Perforatie van het trommelvlies, Perforatie, trommelvlies-, Trommelvliesperforatie
French Perforation de la membrane du tympan, non précisée, Tympan perforé, Perforation de la membrane du tympan, PERFORATION DU TYMPAN, PERFORATION MEMBRANE TYMPANIQUE, Rupture de la membrane tympanique, Perforation tympanique, Perforation du tympan
Italian Perforazione della membrana timpanica, non specificata, Rottura della membrana timpanica, Perforazione della membrana timpanica
Portuguese Membrana do tímpano perfurada, Perfuração da membrana do tímpano NE, Perfuração do Tímpano, PERFURACAO DA MEMBRANA DO TIMPANO, PERFURACAO DOTIMPANO, Perfuração da membrana do tímpano, Perfuração da Membrana Timpânica, Ruptura da Membrana Timpânica
Spanish Perforación de tímpano, Perforación de la membrana timpánica, no especificada, Perforación del tímpano, Perforación del Tímpano, MEMBRANA TIMPANICA, PERFORACION, TIMPANO, PERFORACION, desagarro timpánico, desgarro de la membrana timpánica, desagarro timpánico (hallazgo), desgarro de la membrana timpánica (hallazgo), perforación de membrana timpánica, perforación de membrana timpánica (trastorno), perforación de la membrana timpánica (trastorno), perforación de la membrana timpánica, perforación de la membrana timpánica no especificada (trastorno), perforación de la membrana timpánica, SAI, perforación del tímpano, SAI (trastorno), perforación de la membrana timpánica no especificada, perforación del tímpano, SAI, desgarro del tímpano, perforación del tímpano, Perforación de la membrana timpánica, Perforación de la Membrana Timpánica, Rotura de la Membrana Timpánica
Japanese 鼓膜穿孔、詳細不明, 鼓膜の穿孔, コマクセンコウショウサイフメイ, コマクセンコウ, コマクノセンコウ, 鼓膜穿孔, 鼓膜破裂
Swedish Trumhinneperforation
Finnish Tärykalvoperforaatio
Czech Perforovaný bubínek, Perforace bubínku, blíže neurčená, Perforace bubínku, perforace membrana tympani, perforace tympanické membrány, membrana tympani - perforace, ruptura ušního bubínku, perforace bubínku, perforace ušního bubínku
Korean 상세불명의 고막천공, 고막의 천공
Polish Perforacja błony bębenkowej, Przedziurawienie błony bębenkowej, Przebicie błony bębenkowej, Pęknięcie błony bębenkowej
Hungarian Perforált dobhártya, Dobhártya perforatio, tympanikus hártya perforatiója, nem meghatározott, dobhártya perforatio, dobhártya perforatiója
Norwegian Sprukket trommehinne, Trommehinneruptur, Perforasjon i trommehinne, Trommehinneperforasjon
Derived from the NIH UMLS (Unified Medical Language System)

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