Tympanic membrane rupture: Difference between revisions
| Line 42: | Line 42: | ||
==Management== | ==Management== | ||
===Isolated, Small Perforation=== | ===Isolated, Small Perforation=== | ||
*Antibiotic ear drops for contaminated wounds | *Antibiotic ear drops for contaminated wounds | ||
**Don't give [[Ciprofloxacin]]; can damage the inner ear | **[[Ofloxacin]] is safe for perforation | ||
**''Don't give'' [[Ciprofloxacin]]; can damage the inner ear | |||
*Water precautions (keeping water out of the middle ear), avoid forceful Valsalva | *Water precautions (keeping water out of the middle ear), avoid forceful Valsalva | ||
*Reevaluation with PCM, typical healing within 4-6 weeks | *Reevaluation with PCM, typical healing within 4-6 weeks | ||
Revision as of 13:54, 12 March 2022
Background
Causes
- 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
- May also have:
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
Evaluation
- Typically clinical
Diagnosis
Definition of "complicated or large perforation" (see management):
- Significant hearing loss (≥40 dB)
- Vertigo
- Nystagmus
- Ataxia
- Facial nerve injury
- Large perforation with folded over edges
- Prolonged healing
Management
Isolated, Small Perforation
- Antibiotic ear drops for contaminated wounds
- Ofloxacin is safe for perforation
- Don't give Ciprofloxacin; can damage the inner ear
- Water precautions (keeping water out of the middle ear), avoid forceful Valsalva
- Reevaluation with PCM, typical healing within 4-6 weeks
Isolated, Small Perforation (Pediatric)
- For perforation due to otitis media, PO antibiotics preferred over topical
Complicated or Large Perforation
See Diagnosis section for definition
- As for simple perforations (see above), plus:
- Urgent evaluation by ENT
- Consider CT temporal bone
Disposition
- Outpatient management
- Complicated or larger perforations require expedited ENT follow up