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
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
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