5-Minute Emergency Consult
Tympanic Membrane Perforation
Basics
Description
Perforations can be classified in several ways:
- Duration:
- Acute (<3 mo)
- Chronic (>3 mo)
- Site:
- Pars tensa
- Pars flaccida
- Extent:
- Limited to 1 quadrant (<25%)
- 2 or more quadrants
- Total perforation
Etiology
- Infectious:
- Acute otitis media – most common cause of an acute perforation
- Acute necrotizing myringitis
- Chronic otitis media with effusion
- Traumatic:
- Penetrating trauma (Q-tip, pencil, stick etc.)
- Blunt trauma (slap to the ear, ”boxed ears”); domestic violence, street fight, child abuse, sports (boxing, wrestling)
- Barotrauma; rapid pressure change (diving, flying, hyperbaric oxygen treatment): Rupture usually occurs between 100 and 400 mm Hg (at a depth of 2.6 ft, there is a pressure differential of 60 mm Hg)
- Head injury with fracture
- Forced water injury; diving, water skiing
- Blast injury; extreme noise
- Lightning
- Slag burns; welding or metal work
- Iatrogenic; cerumen or foreign body removal by medical personnel
- Complications of surgical procedures:
- Myringotomy, tympanoplasty, tympanostomy tube insertion
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Citation
Schaider, Jeffrey J., et al., editors. "Tympanic Membrane Perforation." 5-Minute Emergency Consult, 7th ed., Wolters Kluwer, 2027. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307246/1.0.0/Tympanic_Membrane_Perforation_.
Tympanic Membrane Perforation. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Wolters Kluwer; 2027. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307246/1.0.0/Tympanic_Membrane_Perforation_. Accessed July 20, 2026.
Tympanic Membrane Perforation. (2027). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (7th ed.). Wolters Kluwer. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307246/1.0.0/Tympanic_Membrane_Perforation_
Tympanic Membrane Perforation [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Wolters Kluwer; 2027. [cited 2026 July 20]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307246/1.0.0/Tympanic_Membrane_Perforation_.
* Article titles in AMA citation format should be in sentence-case
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T1 - Tympanic Membrane Perforation
ID - 307246
ED - Barkin,Adam Z,
ED - Shayne,Philip,
ED - Rosen,Peter,
ED - Schaider,Jeffrey J,
ED - Barkin,Roger M,
ED - Hayden,Stephen R,
ED - Wolfe,Richard E,
BT - 5-Minute Emergency Consult
UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307246/1.0.0/Tympanic_Membrane_Perforation_
PB - Wolters Kluwer
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DB - Emergency Central
DP - Unbound Medicine
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