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.

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History and Examination

History of

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

Suspicion of cholesteatoma:

Attic defect
Marginal perforation
Crusts
Polyps
Keratin relating to perforation

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 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-Western-ENT- Devon ICB-15N

For children

e-Referral Service Selection:

Specialty: Children's & Adolescent Services
Clinic Type: ENT
Service: DRSS-Western-ENT - (Children)-Devon ICB-15N

Referral Form

DRSS referral form

Pathway Group

This guideline has been signed off on behalf of NHS Devon.

Publication date: 31 May 2016

Referral