II. Etiology

  1. Trauma
    1. Physical abuse red flag
    2. Foreign body
    3. Forceful Ear Irrigation
  2. Infection
    1. Otitis Media
    2. Acute Chronic Otitis Media
  3. Middle Ear Barotrauma (e.g. Scuba Injury)

III. Symptoms

IV. Signs

  1. Size perforation as percent of membrane
  2. Traumatic perforations often lack discharge
  3. Weber lateralizes to side of perforation

V. Management

  1. Keep ear dry
  2. Refer to audiologist
  3. Surgery for large perforations
  4. Treat concurrent Otitis Media if present with antibiotic drops (or oral antibiotics)
    1. Avoid all cortisporin products (including suspension, per new labeling as of 2014)
    2. Ofloxacin otic
    3. Ciprofloxacin eye drops (ciloxan)
    4. Ciprodex

VI. Prognosis

  1. Usually heal well spontaneously in 4-6 weeks
  2. Large or marginal perforations may require surgery

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