1. Perforated Tympanic Membrane (Ruptured ear
drum)
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.