Results Figures
Objective: To evaluate the indications for observation versus surgery in the management of Q-tip induced tympanic membrane perforations (TMP).
Study Design: Retrospective cohort study of 1540 patients with a diagnosis of TMP from 2001-2010.
Patients with a Q-tip injury were subdivided into two groups: observation or surgery.
Methods: Data collected included demographics, symptoms, surgery type, and pre and post-intervention audiometry. Successful outcomes were defined as healed TMP, resolution or improvement of vertigo, tinnitus, or facial nerve paralysis, and/or closure of the air-bone gap (ABG).
Results: Fifty-four of 1540 (3.5%) patients who presented with a TMP were secondary to Q-tip use. Four of the 54 patients (7.4%) underwent delayed surgical repair (5 days-5 months) with 100% success. Preoperatively, one patient had a facial nerve paralysis and two had vertigo, both had perilymphatic fistulae.
Postoperatively, the facial nerve paralysis resolved and only one patient had persistent dizziness. Fifty of 54 patients opted not to undergo surgery with 35 patients who had follow up. Thirty-four (97%) of the 35 patients who followed up had spontaneous healing. The average size of the perforation was 19% and average time to perforation closure was 1.75 months. Twelve of 35 patients had no ABG after healing. Two of 35 patients had dizziness immediately after injury with one having persistent dizziness.
Conclusion: Observation is an appropriate consideration for patients who have a TMP due to a Q-tip injury. Surgical intervention should be offered early when a perilymphatic fistula is suspected, of if there are significant findings such as the presence of facial paralysis, severe vertigo, or profound sensorineural hearing loss. As otolaryngologists, we should be reluctant to offer surgical intervention of an acute injury without significant symptoms as most patients will heal spontaneously within 2 months.