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Referral
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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.
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-Eastern-Ear Nose and Throat-Devon ICB- 15N
For children
e-Referral Service Selection:
- Specialty: Children's & Adolescent Services
- Clinic Type: ENT
- Service: DRSS-Eastern-Child & Adolescent Services-Devon ICB - 15N
Referral Form
Pathway Group
This guideline has been signed off on behalf of NHS Devon.
Publication date: 31 May 2016
Reviewed: April 2024
