Tympanic membrane rupture: Difference between revisions
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**Water precautions (keeping water out of the middle ear) | **Water precautions (keeping water out of the middle ear) | ||
**Reevaluation | **Reevaluation | ||
*In children after TM perforation due to otitis media, PO | *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 | *Significant hearing loss (≥40 dB), vertigo, nystagmus, ataxia, or facial nerve injury | ||
**Urgent evaluation by ENT | **Urgent evaluation by ENT | ||
Revision as of 01:14, 14 July 2016
Background
- Blunt trauma (hand blow to ear, fall, direct hit)
- Penetrating trauma (Q-tip, matchstick, gunshot wound, welding spark)
- Direct ear trauma
- Lightning strike
- Barotrauma
- Blast injury
- Air travel
- Scuba diving
Clinical Features
- Ear pain
- History of barotrauma or direct ear trauma
Differential Diagnosis
Ear Diagnoses
External
- Auricular hematoma
- Auricular perichondritis
- Cholesteatoma
- Contact dermatitis
- Ear foreign body
- Herpes zoster oticus (Ramsay Hunt syndrome)
- Malignant otitis externa
- Otitis externa
- Otomycosis
- Tympanic membrane rupture
Internal
- Acute otitis media
- Chronic otitis media
- Mastoiditis
Inner/vestibular
Diagnosis
- Typically clinical
Management
- 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
Disposition
- Outpatient management