Tympanic membrane rupture: Difference between revisions

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[[File:Gray907.png|thumb|Ear anatomy]]
[[File:Gray907.png|thumb|Ear anatomy]]
===Causes===
===Causes===
*Blunt trauma (hand blow to ear, fall, direct hit)
*[[blunt head trauma|Blunt trauma]] (hand blow to ear, fall, direct hit)
*Penetrating trauma (Q-tip, matchstick, gunshot wound, welding spark)  
*Penetrating trauma (Q-tip, matchstick, gunshot wound, welding spark)  
*Direct ear trauma
*Direct ear trauma
*Lightning strike
*[[Lightning]] strike
*Barotrauma  
*[[Barotrauma]]
**Blast injury
**[[Blast injury]]
**Air travel
**Air travel
**[[Diving Emergencies|Scuba diving]]
**[[Diving Emergencies|Scuba diving]]
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[[File:PerforationTympan.jpg|thumb|Larger perforation (acute)]]
[[File:PerforationTympan.jpg|thumb|Larger perforation (acute)]]
[[File:Otitis chron mesotymp 3.jpg|thumb|Larger perforation (chronic)]]
[[File:Otitis chron mesotymp 3.jpg|thumb|Larger perforation (chronic)]]
*Ear pain
*[[earache|Ear pain]]
*History of barotrauma or direct ear trauma
*History of barotrauma or direct ear trauma
*May also have:
**[[hearing loss]]
**[[Vertigo]]
**[[Nystagmus]]
**[[Ataxia]]
**[[Cranial nerve palsies|Facial nerve injury]]


==Differential Diagnosis==
==Differential Diagnosis==
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**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
*In children after TM perforation due to otitis media, PO antibiotics preferred over topical
*In children after TM perforation due to [[otitis media]], PO [[antibiotics]] preferred over topical
*Significant hearing loss (≥40 dB), vertigo, nystagmus, ataxia, facial nerve injury, large perforation with folded over edges, prolonged healing
*Significant [[hearing loss]] (≥40 dB), [[vertigo]], [[nystagmus]], [[ataxia]], [[cranial nerve palsies|facial nerve injury]], large perforation with folded over edges, prolonged healing
**Urgent evaluation by ENT
**Urgent evaluation by ENT



Revision as of 22:58, 30 September 2019

Background

Ear anatomy

Causes

Clinical Features

Smaller perforation
Larger perforation (acute)
Larger perforation (chronic)

Differential Diagnosis

Ear Diagnoses

External

Internal

Inner/vestibular

Evaluation

  • 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), avoid forceful Valsalva
    • Reevaluation with PCM, typical healing within 4-6 weeks
  • In children after TM perforation due to otitis media, PO antibiotics preferred over topical
  • Significant hearing loss (≥40 dB), vertigo, nystagmus, ataxia, facial nerve injury, large perforation with folded over edges, prolonged healing
    • Urgent evaluation by ENT

Disposition

  • Outpatient management

See Also

References