Tympanic membrane rupture

Background

• Blunt trauma (hand blow to ear, fall, direct hit)
• Penetrating trauma (Q-tip, matchstick, gunshot wound, welding spark)
• Direct ear trauma
• Barotrauma
  • Blast injury
  • Air travel
  • Scuba diving

Clinical Features

Perforated TM

• 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
  • Otic barotrauma

Internal

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

Inner/vestibular

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

Diagnosis

• Typically clinical

Management

• Isolated small tympanic membrane perforations
  • Antibiotic ear drops for contaminated wounds
  • Water precautions (keeping water out of the middle ear)
  • Reevaluation
• Significant hearing loss (≥40 dB), vertigo, nystagmus, ataxia, or facial nerve injury
  • Urgent evaluation by ENT

Disposition

• Outpatient management

See Also

• Otic barotrauma