Traumatic Perforation of the Middle Ear Membrane

6/27/2007

Today a four year old girl was brought in by her mother after her older sibling put a Q-tip into her ear the night before. The child screamed out momentarily at the time that the incident occurred but then went to sleep comfortably. In the morning, Mom noticed a significant amount of blood and pus coming from the ear. On examination there was a distinct perforation of the tympanic (middle ear) membrane as a result of the trauma by the introduction of a Q-tip. The child was prescribed both an oral antibiotic as well as antibiotic drops. Although I frequently do not treat ear infections with antibiotics, this type of infection as a result of a traumatic perforation should be treated aggressively.

I explained to Mom that traumatic perforations are more difficult to resolve than spontaneous perforations that result from a routine ear infection. Spontaneous perforations occur when pus builds up in the middle ear and ruptures the tympanic membrane. Often children with these infections have extreme pain and irritability until the perforation occurs. Once that happens there is almost immediate relief followed by bloody, pussy drainage from the ear. These perforations will often resolve naturally without any major intervention.

Traumatic perforations often do not heal spontaneously and could require a surgical repair. I encouraged Mom to get rid of the Q-tips from the home as they pose a significant danger to children and should never be used to clean the ears. Having them in the home simply encourages their use and allows children access to them when unsupervised. Ear wax should be cleaned with a wash cloth or simple gauze pad. Only clean as far as you can see. Never introduce an object, no matter how apparently safe it looks, into the external ear canal. Even with the most cooperative child, an accident can easily occur resulting in a traumatic perforation.

      

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