Tympanic Membrane Perforation

Tympanic Membrane Perforation is a topic covered in the 5-Minute Emergency Consult.

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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


  • Infection (acute otitis media):
    • Most common cause of an acute perforation
  • Blunt trauma (slap to the ear):
    • Domestic violence, street fight
  • Penetrating trauma (Q-tip)
  • Extrusion of tympanostomy tubes
  • Rapid pressure change (diving, flying):
    • 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)
  • Extreme noise (blast)
  • Lightning
  • Acute necrotic myringitis (β-hemolytic streptococcus)
  • Slag burns (welding or metalworking)
  • Complications of surgical procedures:
    • Myringotomy, tympanoplasty, tympanostomy tube insertion

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