Perforated tympanic membrane (1299/1700)

A 16yo boy presents with acute pain in the right ear and little bleeding from the same ear. He had been in a boxing match and had sustained a blow to the ear. There is little amount of blood in the auditory canal and a small perforation of the eardrum. What is the most appropriate management?

a. Admission for parental antibiotics
b. Nasal decongestant
c. Oral amoxicillin
d. OPD review
e. Packing of ear
f. Surgical intervention
g. Syringing ENT


































answer: D (it will heal on its own) When to give antibiotics? Discharging pus, fever, occurred following otitis media.

The most common cause of a perforated tympanic membrane is infection. Other causes include barotrauma or direct trauma.

A perforated tympanic membrane may lead to hearing loss depending on the size and also increase the risk of otitis media.

Management

• no treatment is needed in the majority of cases as the tympanic membrane will usually heal after 6-8 weeks. It is advisable to avoid getting water in the ear during this time
• it is common practice to prescribe antibiotics to perforations following otitis media
• myringoplasty may be performed if the tympanic membrane does not heal by itself