Tympanic membrane perforation

A 3-year-old male is brought into the emergency department with ear pain. Shortly before arriving he was painting with his older sibling. During the painting activity, some commotion ensued and the child developed acute right ear pain. The examination of the right ear reveals the above image.

The child has a perforation of the tympanic membrane (eardrum) from the pointy end of a paintbrush.

In addition to the circular perforation from the pointy end of the paintbrush, there is significant erythema (redness) and edema (swelling) present that distorts the normal anatomy of the ear. The parents were shown the video from the Wispr and appreciated being able to see the extent of the injury. In addition, the video was uploaded to the EMR system, and Otolaryngology (ENT) was consulted. Usually, eardrum perforations do not require antibiotics. However, in this case, given the possibility of contamination and unknown depth of injury, the child was started on an otic antibiotic drop. The location of the injury (similar in size and location to a tympanostomy tube) suggested that the middle ear ossicles (bones) were spared. The parents were instructed to avoid getting water in the ear until the injury has healed. The child was discharged with antibiotic drops and instructed to follow up in the ENT clinic in a week.

WiscMed thanks Dr. Josh Ross of the University of Wisconsin BerbeeWalsh Department of Emergency Medicine for this submission.