Perforated Tympanic Membrane

Scope

This guideline covers referral of both adults and children with a perforated tympanic membrane, including those interfering with hearing aid function.

Patients with chronic symptomatic perforations or those restricting activity due to recommendation for water exclusion require referral.

Myringoplasty isn't as successful in younger children due to eustachian tube dysfunction; therefore most surgeons wouldn't operate until age 7-8.

Assessment

History and Examination

History of
  • Previous ear disease, surgery or trauma
  • Hearing loss
  • Otalgia
  • Discharge
  • Restriction in activity

​Red Flags

Suspicion of cholesteatoma:

  • Attic defect
  • Marginal perforation
  • Crusts
  • Polyps
  • Keratin relating to perforation

​Management​

Traumatic perforation
  • Do not instrument
  • Water exclusion
  • Advise that 90% will heal within 6 weeks - therefore review at this point
Non-traumatic perforation
e.g. post-acute suppurative otitis media (ASOM)
  • Do not instrument
  • Water exclusion
  • Treat infection with an appropriate formulary choice topical medication see subsection anti-infection preparations
  • Review at 6 months

Referral

Referral Criteria

Traumatic perforation

Consider referral at 6 weeks if not healed or hearing not recovered

Non-traumatic

Consider referral if persists more than 6 months and either causing otalgia, discharge, hearing loss or restriction in activity due to water exclusion

Consider referral if discharging ear and interfering with hearing aid function

Cholesteatoma

Refer urgently if possible cholesteatoma

Referral Instructions

For adults

e-Referral Service Selection:

  • Specialty: ENT
  • Clinic Type: Ear
  • Service: DRSS-South Devon & Torbay-Ear Nose and Throat- Devon CCG -15N
For children

e-Referral Service Selection:

  • Specialty: Children's & Adolescent Services
  • Clinic Type: ENT
  • Service: DRSS-South Devon & Torbay-Children's & Adolescent Services- Devon CCG - 15N

Referral Forms

DRSS referral form

Torbay and South Devon seeking advice form

Supporting Information

Pathway Group

This guideline has been signed off by South Devon and Torbay CCG

Publication date: October 2017

 

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