Tympanic membrane rupture

Background

Ear anatomy

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

Smaller perforation

Larger perforation (acute)

Larger perforation (chronic)

• Ear pain
• History of barotrauma or direct ear trauma
• May also have:
  • hearing loss
  • Vertigo
  • Nystagmus
  • Ataxia
  • Facial nerve injury

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
  • Otic barotrauma

Internal

• Acute otitis media
  • Bullous myringitis
• Chronic otitis media
• Mastoiditis

Inner/vestibular

• Labyrinthitis, vestibular neuritis
• Meniere's disease
• Sudden sensorineural hearing loss

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 - ciprofloxacin suspension (more appropriately viscous than solution)
  • 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 above, plus:
  • Urgent evaluation by ENT

Disposition

• Outpatient management

See Also

• Otic barotrauma
• Ear diagnoses