Traumatic Tympanic Membrane Perforations Diagnosed in Emergency Departments | Emergency Medicine | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
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Original Investigation
February 2018

Traumatic Tympanic Membrane Perforations Diagnosed in Emergency Departments

Author Affiliations
  • 1Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
  • 2Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark
  • 3Department of Otolaryngology–Head and Neck Surgery, University of Maryland, Baltimore
  • 4Department of Otolaryngology–Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan
  • 5Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark
  • 6Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark
  • 7Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark
JAMA Otolaryngol Head Neck Surg. 2018;144(2):136-139. doi:10.1001/jamaoto.2017.2550
Key Points

Question  What are the leading causes of traumatic tympanic membrane perforation in the United States?

Findings  In this cross-sectional analysis of 949 emergency department visits, foreign body instrumentation (including cotton-tipped applicators) was the most frequent cause of traumatic tympanic membrane perforations.

Meaning  The leading cause of traumatic tympanic membrane perforations may be preventable, and patient education may prevent this frequent cause of injury.

Abstract

Importance  Tympanic membrane perforations (TMPs) are frequent events leading to evaluation in the primary care and otolaryngology offices or the emergency department (ED). Despite specific warning labels on packaging of cotton-tipped applicators regarding the risk of injury to the ear canal with personal use, these products are commonly used to remove ear cerumen.

Objective  To analyze the mechanism of injury for traumatic TMPs among patients presenting to the ED.

Design, Setting, and Participants  Cross-sectional analysis of cases from 100 emergency departments in the United States. The National Electronic Injury Surveillance System was searched on April 3, 2015, for ear-related injuries with analysis information regarding patient age, patient sex, time and date of injury, specific injury diagnoses, and specific injury mechanisms that occurred across 5 years, from January 1, 2010, through December 31, 2014.

Main Outcomes and Measures  Diagnoses of traumatic TMP documented in the ED visit record as well as patient demographics, diagnoses, and other aspects of the injury, including mechanism of injury.

Results  There were 949 case entries in the database for traumatic TMP, which extrapolates to 4852 ED visits nationally. Of 949 patients evaluated, 568 (59.8%) were men and 381 (40.2%) were women resulting in a male to female ratio of 1.49:1. Most injuries occurred in patients 18 years or younger (602 of 949 [63.4%]) with children younger than 6 years most at risk (331 of 949 [34.9%]). Ear canal instrumentation including foreign bodies was noted in 581 of 949 cases (61.2%), with cotton-tipped applicators noted in 261 (44.9%) of these cases. While foreign body instrumentation represented the leading cause of traumatic TMP in patients aged 0 to 5 years (284 of 331 cases [85.8%]), 6 to 12 years (108 of 158 [68.4%]), 19 to 36 years (85 of 223 [38.1%]), 37 to 54 years (48 of 91 [52.7%]), and 55 years or older (22 of 33 [66.7%]), water trauma was the leading cause of TMP in patients aged 13 to 18 years (43 of 113 cases [38.1%]).

Conclusions and Relevance  Traumatic TMP represents a common reason for evaluation in the ED. Despite common warnings regarding risk of injury to the tympanic membrane with use of a cotton-tipped applicator, it is still a major cause of traumatic TMPs. Other injury mechanisms also play an important role in the teenage and young adult populations.

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