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Tympanic Membrane Perforation

Initial Diagnosis and Management
Initial Management:

Management strategies are initially focused on the etiology. Acute and/or chronic infections as well as eustachian tube dysfunction should be treated medically. The majority of tympanic perforations undergo spontaneous closure with conservative care. Patients should be instructed to keep water out of the ear during healing especially during bathing and swimming. Patients may use a large cotton ball saturated with vaseline (petrolatum) jelly placed onto the outer ear opening to prevent water from entering the ear.

Ongoing Management and Objectives

Ongoing management should focus on prevention of infection and documentation of spontaneous perforation closure.

Indications for Specialty Care Referral

An audiogram showing conductive hearing loss associated with a TM perforation.

Traumatic perforation with any of the following: flap of TM into middle ear, vertigo, or hearing loss. Call ENT Clinic and refer immediately.

Recurrent middle ear infections associated with a TM perforation.

Patient desires to participate in water activities AND surgical correction with an otherwise stable perforation without infection or hearing loss.

Criteria for Return to Primary Care

Resolution of the problem by medical or surgical therapy.