| ID | 278 |
|---|---|
| Name | TRAUMATIC RUPTURE OF THE TYMPANIC MEMBRANE1 |
| Cause | Traumatic perforation of the tympanic membrane (TM) can cause pain, bleeding, hearing loss, tinnitus, and vertigo. Diagnosis is based on otoscopy. Treatment often is unnecessary. Antibiotics may be needed for infection. Surgery may be needed for perforations persisting > 2 months, disruption of the ossicular chain, or injuries affecting the inner ear. |
| Signs Symptoms | Ear pain that may subside quickly. Mucuslike, pus-filled or bloody drainage from the ear. Hearing loss. Ringing in the ear (tinnitus) Spinning sensation (vertigo) Nausea or vomiting that can result from vertigo. |
| Diagnosis | Otoscopy Audiometry Perforation is generally evident on otoscopy. Any blood obscuring the ear canal is carefully suctioned at low pressures. Irrigation and pneumatic otoscopy are avoided. Extremely small perforations may require otomicroscopy or middle ear impedance studies for definitive diagnosis (eg, if perforations do not close). If possible, audiometric studies are done before and after treatment to avoid confusion between trauma-induced and treatment-induced hearing loss. |
| Investigations | Diagnosis is based on otoscopy |
| Management | Management: 1. No cleaning, no syringing, no ear drop is necessary,. 2. Swimming & bathing in ponds is avoided. 3. If there is chance of infection, then penicillin is administered orally or systemically in proper dose & duration. 4. If associated with cold, then nasal decongestants (e.g oxymetazoline nasal drop), antihistamine preparations are to be used. 5. If attends with purulent discharge then manage the case as in acute otitis media with perforation. 6. If the above measures and treatment fail to heal in six months, myringoplasty is the choice of treatment. |
| Introduction | |
| History | |
| Etiology | See under causes |
| Clinical Features | Clinical features: 1. Deafness 2. Tinnitus 3. Earache 4. Vertigo 5. Bleeding or sero-sanguinous discharge 6. Perforation of tympanic membrane usually posterior segment and 7. Infection resulting in otitis media. |
| Preventions | |
| Treatment | ar kept dry Oral or topical antibiotics if dirty injury Sometimes surgery Often, no specific treatment is needed. The ear should be kept dry; routine antibiotic ear drops are unnecessary. However, prophylaxis with oral broad-spectrum antibiotics or antibiotic ear drops is necessary if contaminants may have entered through the perforation as occurs in dirty injuries. If the ear becomes infected, amoxicillin 500 mg orally every 8 hours is given for 7 days. Although most perforations close spontaneously, surgery is indicated for a perforation persisting > 2 months. Persistent conductive hearing loss suggests disruption of the ossicular chain, necessitating surgical exploration and repair. |
| Complications | Hearing loss, chronic otitis media, cholesteatoma, and mastoiditis |
| Prognosis | |
| Types | |
| Classification | |
| Observation | |
| Pathology |
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