Tympanic membrane rupture

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  • Blunt trauma (hand blow to ear, fall, direct hit)
  • Penetrating trauma (Q-tip, matchstick, gunshot wound, welding spark)
  • Direct ear trauma
  • Lightning strike
  • Barotrauma

Clinical Features

Perforated TM
  • Ear pain
  • History of barotrauma or direct ear trauma

Differential Diagnosis

Ear Diagnoses


  • Typically clinical


  • Isolated small tympanic membrane perforations
    • Antibiotic ear drops for contaminated wounds - ciprofloxacin suspension (more appropriately viscous than solution)
    • Water precautions (keeping water out of the middle ear)
    • Reevaluation
  • In children after TM perforation due to otitis media, PO antibiotics preferred over topical
  • Significant hearing loss (≥40 dB), vertigo, nystagmus, ataxia, or facial nerve injury
    • Urgent evaluation by ENT


  • Outpatient management

See Also