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CC March 2017 Tympanic Membrane Performation

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echoecho's version from 2017-05-29 18:50

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Question Answer
What is the tympanic membrane (TM)?it is a thin structure composed of the pars tensa and pars flaccida that converts sound energy in the auditory canal to mechanical energy hrough vibration of the middle ear ossicles
What is TM perforation?it is a hole in the membrane that may be caused by infection, trauma or medical therapy
Do TM perforations vary by size and location? Do they vary in healing times?yes; yes
What is the true incidence of TM perforation?unknown
What is the most common cause of perforation?infection
What is the pathophysiology of TM perforation if acute otitis media is the cause?relative ischemia of the TM and the middle ear effusion exerts pressure on the TM
If perforation occurs, what does the patient report?sudden decrease in ear pain that is often associated with otorrhea
Otitis externa can be a cause of otorrhea but is it a common cause of perforation?no, it is an uncommon cause
What should be prescribed if AOM is suspected as a cause of otorrhea (pt is febrile, has ear pain, other upper respiratory symptoms)?oral antibioics covering the usual pathogens (Streptococcus pneumonia, Haemophilus influenza, Moraxella catarrhalis) - usually Amoxicillin
After how long should the TM be reexamined to assess presence of a perforation?7-10 days
*** Treatment with topical antibiotics only is NOT recommended and potentially otoxic ear drops containing?1) gentamicin (Pred-G) 2) neomycin (Cortisporin) or Tobramycin (TobraDex) should be avoided in any situation with a TM perforation
Perforations will usually heal spontaneously regardless of size and number of recurrences. If a perforation has not healed ___ to ___ weeks after its initial presentation, patients should be referred to an ENT for surgical repair?4; 8
What should patient avoid getting into the affected ear? why?1) water 2) it increases the risk of subsequent otitis media or mastoiditis
List 3 other traumatic causes of TM perforation?1) barotrauma from inappropriate ascent or descent while scuba diving 2) close proximity to an explosion WITHOUT proper ear protection 3) direct blow to the ear
What symptoms do patients reports with a TM perforation?1) decreased hearing (more likely with larger perforations) 2) whistling sound when they sneeze or blow their nose
While there may have been pain associated with barotrauma, is the perforation itself painful?no
Traumatic perforations will usually heal spontaneously in ___ to ___ weeks?4; 8
Why should patients (swimmers, divers, pilots) see an ENT earlier?for quality of life issues
List a medical-related perforation that may be inadvertent? intentional?1) during removal of cerumen 2) as part of myringotomy tube placement
What treatment is indicated for inadvertent perforations? Previous perforation should preclude what?1) observation 2) future irrigations
Surgically-created perforations close after the tubes fall out, but persistent perforations should require what?reevaluation by ENT
Should AOM occur in a child with myringotomy tubes, a randomized, controlled trial found that _____ treatment was MORE effective than oral treatment?topical
*** SUMMARY =What is the most common cause of TM perforation?infection
*** SUMMARY = Perforation usually heal spontaneously within ____ months?several
*** SUMMARY = Surgical repair is an option for what 2 patient types?1) those who desire rapid closure 2) those who do not have spontaneous healing
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