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Traumatic Perforation of the Tympanic Membrane


Taha A. Jan

, MD, Vanderbilt University Medical Center

Reviewed/Revised Jan 2024
Topic Resources

Traumatic perforation of the tympanic membrane can cause pain, bleeding, hearing loss, tinnitus, and vertigo. Diagnosis is based on otoscopy. Treatment often is unnecessary. Antibiotics may be needed to prevent or treat infection. Surgery may be needed to treat perforations persisting for > 2 months, disruption of the ossicular chain, or injuries affecting the inner ear.

Traumatic causes of tympanic membrane perforation include

Penetrating injuries of the tympanic membrane may result in dislocations of the ossicular chain, fracture of the stapedial footplate, displacement of fragments of the ossicles, bleeding, a perilymph fistula from the oval or round window resulting in leakage of perilymph into the middle ear space, or facial nerve injury.

Symptoms and Signs of Traumatic TM Perforation

Diagnosis of Traumatic TM Perforation

  • Otoscopy

  • Audiometry

Perforation is usually evident during 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.

Treatment of Traumatic TM Perforation

  • Dry ear precautions

  • Topical antibiotics for contaminated injuries

  • Sometimes surgery

Often, no specific treatment is needed other than maintaining dry ear precautions. Dry ear precautions include occluding the external canal (eg, using a cotton ball lathered with petroleum jelly) while bathing and showering and avoiding swimming. Routine antibiotic ear drops are unnecessary. However, prophylaxis with antibiotic ear drops is necessary if contaminants may have entered through the perforation as occurs in dirty injuries.

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.

If the ear becomes infected, amoxicillin 500 mg orally every 8 hours can be given for 7 days, however, typically topical therapy with fluoroquinolone ear drops (ciprofloxacin or ofloxacin) alone is sufficient. Ear drops that contain aminoglycosides (eg, neomycin, tobramycin) or polymyxin should not be prescribed for patients with a perforated tympanic membrane or a tympanostomy tube because of potential ototoxicity.

Key Points

  • Many perforations are small and heal spontaneously.

  • Instruct patients to keep their ear dry during healing; topical or systemic antibiotics are unnecessary unless contamination is significant or infection develops.

  • Surgically repair damage to the ossicles and perforations that persist > 2 months.

Drugs Mentioned In This Article

Drug Name Select Trade
Amoxil, Dispermox, Moxatag, Moxilin , Sumox, Trimox
Cetraxal , Ciloxan, Cipro, Cipro XR, OTIPRIO, Proquin XR
Floxin, Ocuflox
AK-Tob, BETHKIS, Kitabis Pak, Nebcin, Tobi, TOBI Podhaler, Tobrasol , Tobrex
NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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