Tympanic membrane rupture: Difference between revisions
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==Background== | ==Background== | ||
*Blunt trauma (hand blow to ear, fall, direct hit) | [[File:Gray907.png|thumb|Ear anatomy]] | ||
===Causes=== | |||
*[[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]] | ||
==Clinical Features== | ==Clinical Features== | ||
[[File:PerforationTympan.jpg|thumb| | [[File:Otitis chron mesotymp 4.jpg|thumb|Smaller perforation]] | ||
*Ear pain | [[File:PerforationTympan.jpg|thumb|Larger perforation (acute)]] | ||
[[File:Otitis chron mesotymp 3.jpg|thumb|Larger perforation (chronic)]] | |||
*[[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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==Evaluation== | ==Evaluation== | ||
*Typically clinical | *Typically clinical | ||
===Diagnosis=== | |||
Definition of "complicated or large perforation" (see management): | |||
*Significant [[hearing loss]] (≥40 dB) | |||
*[[Vertigo]] | |||
*[[Nystagmus]] | |||
*[[Ataxia]] | |||
*[[Cranial nerve palsies|Facial nerve injury]] | |||
*Large perforation with folded over edges | |||
*Prolonged healing | |||
==Management== | ==Management== | ||
===Isolated, Small Perforation=== | |||
*Antibiotic ear drops for contaminated wounds | |||
**[[Ofloxacin]] is safe for perforation | |||
**Ciprofloxacin 0.3% and dexamethasone 0.1% otic suspension - Non-ototoxic; may use if TM is known or suspected to be nonintact, Often used for treatment of mild to moderate disease | |||
* | *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 | **Urgent evaluation by ENT | ||
**Consider CT temporal bone | |||
==Disposition== | ==Disposition== | ||
*Outpatient management | *Outpatient management | ||
**Complicated or larger perforations require expedited ENT follow up | |||
==See Also== | ==See Also== | ||
*[[Otic barotrauma]] | *[[Otic barotrauma]] | ||
*[[Ear diagnoses]] | |||
==External Links== | |||
==References== | ==References== | ||
Latest revision as of 05:06, 19 October 2023
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
- Ciprofloxacin 0.3% and dexamethasone 0.1% otic suspension - Non-ototoxic; may use if TM is known or suspected to be nonintact, Often used for treatment of mild to moderate disease
- 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