From the Guidelines
Patients with tympanic membrane perforations can be discharged from ENT clinic follow-up when the perforation has completely healed, hearing has returned to baseline or acceptable levels, and there are no signs of infection or complications. The discharge criteria should prioritize the patient's morbidity, mortality, and quality of life, ensuring that the tympanic membrane has adequately healed and that the patient's hearing function has been optimized before concluding specialist care. Some key points to consider when determining discharge criteria include:
- The size of the perforation, with small perforations (less than 25% of the membrane) often healing spontaneously within 6-8 weeks 1
- The presence of any signs of infection, such as otorrhea (ear discharge), which should be absent for at least 4-6 weeks before discharge
- The stability of the ear and the presence of any middle ear disease, such as cholesteatoma
- The results of a final audiogram, which should confirm hearing restoration or stabilization
- Patient education on avoiding water entry into the ear if any residual perforation exists and instructions to return if they experience symptoms such as hearing loss, ear discharge, pain, or dizziness. For larger perforations that required surgical intervention, such as tympanoplasty, discharge is appropriate after post-operative healing is complete, usually 3-6 months following surgery, with evidence of graft take and improved hearing 1. It is essential to prioritize the patient's quality of life and ensure that they are asymptomatic and have no signs of complications before discharging them from ENT clinic follow-up.
From the Research
Discharge Criteria from ENT Clinic Follow-up for Tympanic Membrane Perforation
The discharge criteria from ENT clinic follow-up for tympanic membrane perforation are not explicitly stated in the provided studies. However, the studies provide information on the healing process of tympanic membrane perforations and the effects of different ear drops on the healing process.
- The studies suggest that most tympanic membrane perforations can be managed with conservative care and do not require surgical repair 2.
- The healing time of tympanic membrane perforations can be affected by the type of ear drops used, with ofloxacin ear drops showing a significant effect on closure of TM perforations and reducing healing time 3.
- Ciprofloxacin/dexamethasone ear drops have been shown to delay the healing of tympanic membrane perforations, while ofloxacin ear drops do not appear to have a significant effect on healing time 4, 5, 6.
- The decision to discharge a patient from ENT clinic follow-up may depend on various factors, including the size and location of the perforation, the presence of any underlying conditions, and the patient's overall health status.
Factors to Consider for Discharge
When considering discharge from ENT clinic follow-up, the following factors may be taken into account:
- The perforation has healed completely
- The patient's symptoms have resolved
- There are no signs of infection or other complications
- The patient has been educated on how to manage their condition and prevent further complications
- The patient has been scheduled for follow-up appointments as needed to monitor their condition 2.