A tympanic membrane perforation is a hole in the eardrum, most often caused by acute otitis media, trauma such as cotton swabs or a slap, or sudden pressure changes. Most small perforations heal on their own within weeks.
Key symptoms
- Sudden ear pain that may ease when the eardrum ruptures
- Ear discharge, sometimes bloody
- Muffled hearing
- Tinnitus
- Brief vertigo in some cases
What you find on exam
- Otoscopy: visible hole in the eardrum
- Discharge in the ear canal
- Tuning fork tests: conductive pattern
- Facial nerve function and nystagmus
- Other injuries in trauma
Tests
- Otoscopy confirms the diagnosis
- Audiogram if hearing loss persists
- Culture of discharge if chronic or not improving
- CT of the temporal bone after major head trauma
Treatment basics
- Keep the ear dry: no swimming, cotton with petroleum jelly when showering
- Ofloxacin or ciprofloxacin ear drops if infected or draining
- Avoid aminoglycoside ear drops, which can damage the inner ear
- Pain control with acetaminophen or ibuprofen
- ENT follow-up; tympanoplasty if not healed after about 3 months
Red flags
- Vertigo, nystagmus or severe hearing loss (inner ear injury)
- Facial weakness
- Clear fluid draining after head trauma
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.