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Tympanic Membrane Perforation

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Tympanic Membrane Perforation, Tympanic Membrane Rupture, TM Perforation, TM Rupture

  • 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)
  • Symptoms
  • Signs
  1. Size perforation as percent of membrane
  2. Traumatic perforations often lack discharge
  3. Weber lateralizes to side of perforation
  • 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 environment (and also keep canal dry)
    2. Preparations: Antibiotic drops - 100x oral concentration (may also add oral aminopenicillin antibiotics)
      1. Avoid all cortisporin products (including suspension, per new labeling as of 2014)
      2. Ofloxacin otic
      3. Ciprofloxacin eye drops (ciloxan)
      4. Ciprodex
  • Prognosis
  1. Usually heal well spontaneously (95% of cases) in 4-6 weeks
  2. Large or marginal perforations may require surgery
  • References
  1. Orman and Finley in Herbert (2018) EM:Rap 18(3):14