3.04 Perforated Tympanic Membrane (Ruptured ear drum)

agk’s Library of Common Simple Emergencies

Presentation

The patient will present with ear pain after barotrauma, such as a blow to the ear or deep-water diving; or after direct trauma with a stick or other sharp object. Hemorrhage will often be noticed within the external canal and the patient will experience some hearing loss. Tinnitus or vertigo may also be present. Otoscopic examination will reveal a defect in the tympanic membrane that may or may not be accompanied by disruption of the ossicles.

What to do:

• Clear out any debris from the canal, using gentle suction.
• Test for nystagmus and gross hearing loss.
• Place a protective cotton plug inside of the ear canal and instruct the patient to keep the canal dry.
• Prescribe an appropriate analgesic (e.g., ibuprofen, naproxen, acetaminophen with codeine or oxycodone).
• Insure that the patient gets early follow up by an otolaryngologist.

What not to do:

• Do not instill any fluid into the external canal or allow the patient to get water into his ear. Water in the middle ear is painful, irritating and may introduce bacteria. Covering the cotton plug with petroleum jelly will allow the patient to shower safely.

Discussion

Small uncomplicated perforations usually heal. When there is nystagmus, vertigo, profound hearing loss, or disruption of the ossicles, then early otolaryngologic consultation is advisable.

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