Chapter 69: Tympanic Membrane Perforation

Buttaro: Primary Care: A Collaborative Practice, 6th Edition

Multiple Choice

1. A patient reports ear pain and difficulty hearing. An otoscopic examination reveals a small tear in the tympanic membrane of the affected ear with purulent discharge. What is the initial treatment for this patient?

a. Insert a wick into the ear canal.

b. Irrigate the ear canal to remove the discharge.

c. Prescribe antibiotic ear drops.

d. Refer the patient to an otolaryngologist.

ANS: C a. Order antibiotic ear drops if signs of infection occur. b. Prescribe analgesics and follow up in 1 to 2 days. c. Reassure the patient that this will heal without problems. d. Refer the patient to an otolaryngologist for evaluation.

This perforation is most likely due to infection and should be treated with antibiotic ear drops. Wicks are used for otitis externa. The ear canal should not be irrigated to avoid introducing fluid into the middle ear. It is not necessary to refer unless the perforation does not heal.

2. A patient reports ear pain after being hit in the head with a baseball. The provider notes a perforated tympanic membrane. What is the recommended treatment?

ANS: D

Patients with traumatic or blast injuries causing perforations of the tympanic membranes should be referred to specialists to determine whether damage to inner ear structures has occurred. For an uncomplicated perforation, the other interventions are all appropriate.

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