From the Guidelines
Tympanic membrane perforation should be managed with a non-ototoxic topical preparation, as recommended by the clinical practice guideline for acute otitis externa 1. When a patient has a known or suspected perforation of the tympanic membrane, including a tympanostomy tube, it is essential to prioritize the use of non-ototoxic topical preparations to avoid further damage or complications.
Key Considerations
- The ear should be kept dry to prevent infection, and cotton balls coated with petroleum jelly can be used as protection during bathing or swimming.
- Antibiotic ear drops, such as ciprofloxacin 0.3% (4 drops twice daily for 7-10 days), may be prescribed if there is an infection present 1.
- Oral antibiotics like amoxicillin (500mg three times daily for 7-10 days) might be needed for more severe infections.
- Pain can be managed with acetaminophen (500-1000mg every 6 hours) or ibuprofen (400-600mg every 6-8 hours).
- Avoid inserting objects into the ear or performing Valsalva maneuvers, as this can exacerbate the condition.
Treatment and Follow-up
If the perforation does not heal within 3 months, is large (>50% of the eardrum), or causes significant hearing loss, surgical repair (tympanoplasty) may be necessary 1. Perforations can lead to conductive hearing loss because the damaged eardrum cannot efficiently transmit sound vibrations to the middle ear. Prompt evaluation by a healthcare provider is crucial to assess the extent of damage and determine appropriate treatment. It is also important to note that the presence of a non-intact tympanic membrane may limit the options available for cerumen removal, and mechanical removal of cerumen is the preferred technique when the eardrum is not intact 1.
From the Research
Causes and Effects of Tympanic Membrane Perforation
- Tympanic membrane perforation may be caused by trauma or acute/chronic middle ear infection, leading to conductive hearing loss 2
- Perforation can predispose to infections, making it essential to keep the ear dry 2
Healing Process
- In most cases, traumatic perforations heal spontaneously 2
- Perforations caused by acute middle ear infections are treated with antibiotics 2
- Chronic perforation due to chronic middle ear infection or cholesteatoma usually requires surgery to heal 2
Impact of Medications on Healing
- Ciprofloxacin/dexamethasone can delay the healing of tympanic membrane perforations, while ofloxacin does not have a significant impact 3, 4, 5
- The combination of ciprofloxacin and dexamethasone can potentiate the delay in healing 5
- However, a clinical study found no significant difference in perforation closure rates after endoscopic tympanoplasty with or without the use of ciprofloxacin-dexamethasone ear drops 6