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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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Rosen, Peter, et al., editors. "Tympanic Membrane Perforation." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307246/all/Tympanic_Membrane_Perforation.
Tympanic Membrane Perforation. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307246/all/Tympanic_Membrane_Perforation. Accessed April 23, 2019.
Tympanic Membrane Perforation. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307246/all/Tympanic_Membrane_Perforation
Tympanic Membrane Perforation [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 23]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307246/all/Tympanic_Membrane_Perforation.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Tympanic Membrane Perforation ID - 307246 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307246/all/Tympanic_Membrane_Perforation PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -