Acute tympanic membrane (TM) perforations maybe caused by direct penetrating trauma, barotrauma, OM, corrosives, thermal injuries, or iatrogenic causes (foreign-body removal, tympanostomy tubes). TM perforations are occasionally accompanied by injuries to the ossicular chain and temporal bone.
Patients with an acute TM perforation complain of a sudden onset of ear pain, vertigo, tinnitus, and altered hearing after a specific event. Physical examination of the TM reveals a slit-shaped tear or a larger perforation with an irregular border, often associated with blood along the margins. Subacute or chronic perforations have smooth margins and a round or ovoid shape.
Management and Disposition
Treatment of acute TM perforations is tailored to the mechanism of injury. All easily removable foreign bodies should be extracted. Corrosive exposures require face, eye, and ear decontamination. Antibiotics and irrigation do not improve the rate or completeness of healing unless the injury is associated with OM. Systemic antibiotics should be reserved for perforations associated with OM, penetrating injury, and possibly water-sport injuries (see “Otitis Media” earlier). Topical steroids impede perforation healing and should not be used.
Patients are instructed to avoid water in the ear while the perforation is healing and to return if symptoms of infection appear. While nearly 80% of all TM perforations heal spontaneously, all TM perforations require referral to an otolaryngologist for follow-up and for possible myringoplasty.
Corticosteroid eardrops of any formulation retard spontaneous healing and should be avoided.
Topical ototoxic medications (eg, gentamycin, neomycin sulfate, tobramycin) should be avoided.
Traumatic TM perforation associated with cranial nerve (CN) deficits or persistent vertigo requires immediate otolaryngology consultation due to possible temporal bone fractures or injury to the round or oval window.
Acute Tympanic Membrane Perforation. An acute tympanic membrane perforation is seen. Note the sharp edges of the ruptured tympanic membrane. (Photo contributor: Richard A. Chole, MD, PhD.)