The most common complaints include hearing loss and acute pain. Bloody otorrhea is possible. The first step is to visualize the perforation using otoscopy and clean the ear canal. The perforation can appear slit-shaped or with irregular borders. All patients should be instructed to take water precautions.
Most perforations will heal spontaneously. These patients should be referred to an otolaryngologist for follow-up within a few weeks. Those that do not heal on their own will be considered for surgery.
Patient may present with history of:
- Most commonly, penetrating trauma (usually accidental, self-inflicted, eg, Q-tip damage)
- Thermal trauma in welders (molten slag enters ear)
- Explosive barotrauma (device detonation, fireworks, lightning)
- Nonexplosive barotrauma blasts (slap to the ear, airbag deployment, sports, recreational water activities)
Both early and late presentation:
- Hearing loss
- Ear pain
- Nausea and vomiting
- Fascial weakness
- Vertigo
- Imbalance
- Tinnitus
- Vertigo (more severe injury if persistent)
- Bloody otorrhea
- Chronic suppurative ear disease (chronic otitis media)
- Purulent otorrhea (indicates chronic disease)
- Larger perforations
- Ossicular discontinuity more common
- Cholesteatoma
- Fascial nerve injuries
- Perilymph fistula
- Hemotympanum
- Amber or clear middle ear effusion
- Otorrhea
- Hearing deficit by Weber and Rinne tuning fork tests
- Nystagmus
- Ataxia
- Retroauricular hematoma