What is the treatment for tympanic membrane (eardrum) perforation?

From the Guidelines

Treatment for an eardrum rupture typically involves allowing the eardrum to heal on its own, along with measures to prevent infection and manage pain. Here's a concise treatment plan:

• Keep the ear dry: Use a waterproof ear plug or cotton ball coated with petroleum jelly when showering or swimming for 4-6 weeks.
• Pain management: Take over-the-counter pain relievers like acetaminophen or ibuprofen as needed.
• Antibiotic ear drops: If prescribed, use ofloxacin or ciprofloxacin drops, 3-4 drops in the affected ear twice daily for 7-10 days to prevent infection, as recommended by the 2014 clinical practice guideline for acute otitis externa 1.
• Avoid blowing your nose forcefully or "popping" your ears.
• Follow-up with an ENT specialist in 2-3 weeks to assess healing. Most eardrum ruptures heal within 6-8 weeks without surgical intervention. The body's natural healing process usually closes the perforation. Keeping the ear dry prevents water and bacteria from entering the middle ear, reducing infection risk. Pain management and antibiotics help with discomfort and potential infections. Avoiding pressure changes in the ear allows for undisturbed healing. In rare cases where the rupture doesn't heal on its own, surgical repair (tympanoplasty) may be necessary, as discussed in the 2017 panel on otitis media treatment and complications 1.

The 2013 clinical practice guideline for tympanostomy tubes in children also highlights the importance of considering the risks and benefits of surgical intervention, including the potential for tympanostomy tube otorrhea and the need for ongoing surveillance 1. However, the most recent and highest quality study, the 2017 panel on otitis media treatment and complications, provides the most up-to-date guidance on the treatment of eardrum rupture, emphasizing the importance of accurate diagnosis and optimal management of ear pain 1.

It is essential to prioritize the patient's quality of life and minimize the risk of complications, such as hearing loss and infection, when managing an eardrum rupture. By following the recommended treatment plan and seeking regular follow-up care, patients can reduce their risk of complications and promote optimal healing.

From the FDA Drug Label

The recommended dosage regimen for the treatment of chronic suppurative otitis media with perforated tympanic membranes in patients 12 years and older is: Ten drops (0.5 mL, 1. 5 mg ofloxacin) instilled into the affected ear twice daily for fourteen days.

• Treatment for tympanic membrane (eardrum) perforation is ofloxacin (OTIC) ear drops, with a dosage of 10 drops (0.5 mL, 1.5 mg ofloxacin) instilled into the affected ear twice daily for fourteen days 2.
• The patient should lie with the affected ear upward, before instilling the drops, and then pump the tragus 4 times by pushing inward to facilitate penetration into the middle ear.
• This position should be maintained for five minutes.

From the Research

Treatment for Tympanic Membrane Perforation

The treatment for tympanic membrane (eardrum) perforation can vary depending on the cause and severity of the perforation. Some studies suggest the use of ofloxacin otic drops to promote healing and prevent infection.

• Ofloxacin otic solution 0.3% has been shown to be effective in the treatment of chronic suppurative otitis media in adolescents and adults with perforated tympanic membranes, with a clinical cure rate of 75 to 91% 3.
• The use of ofloxacin otic drops has been found to shorten the closure time and improve the closure rate of traumatic tympanic membrane perforations, particularly for large perforations 4, 5.
• However, other studies have found that the use of ofloxacin otic drops does not significantly affect the rate of otorrhoea (discharge) or hearing improvement 4, 5.

Medical Management

Medical management of tympanic membrane perforation may include the use of topical antibiotics, such as ofloxacin, to prevent infection and promote healing.

• Topical antibiotics, such as ofloxacin, have been shown to be effective in the treatment of otitis externa and otitis media in patients with tympanic membrane perforations or tympanostomy tubes 3.
• However, the use of oral antibiotics, such as amoxicillin clavulanate, may also be effective in the treatment of discharge associated with grommets (ventilation tubes) 6.

Surgical Management

In some cases, surgical management may be necessary to repair the perforated tympanic membrane.

• Myringotomy and insertion of ventilation tubes may be necessary to treat chronic serous otitis media accompanied by bloody effusion 7.
• Modified radical mastoidectomy, placement of silicone rubber sheeting in the middle ear, and insertion of a ventilation tube may be necessary in rare cases where the condition has progressed to a state of intractability 7.