From the Guidelines
A perforated tympanic membrane should be managed with watchful waiting for small perforations, and topical quinolone ear drops for those with discharge, as they have been shown to be effective in clearing aural discharge in the short term. For small perforations, watchful waiting for 1-3 months is often recommended as many heal spontaneously. During this time, keep the ear dry by using earplugs or cotton balls coated with petroleum jelly while showering, and avoid swimming. For pain management, acetaminophen (500-1000mg every 6 hours) or ibuprofen (400-600mg every 6-8 hours) can be used. If there's discharge, topical quinolone ear drops, such as ciprofloxacin/dexamethasone, are recommended due to their effectiveness in clearing aural discharge in the short term, as shown in a study published in Nature Reviews Disease Primers 1.
Some key points to consider in managing a perforated tympanic membrane include:
- Keeping the ear dry to prevent infection
- Avoiding swimming and using earplugs or cotton balls coated with petroleum jelly while showering
- Using pain management medications such as acetaminophen or ibuprofen
- Prescribing topical quinolone ear drops for discharge, as they are non-ototoxic and effective in clearing aural discharge, as recommended by a clinical practice guideline published in Otolaryngology--head and neck surgery 1
- Considering surgical repair (tympanoplasty) for larger perforations or those that do not heal.
It's essential to note that perforations typically result from infections, trauma, or pressure changes, and can cause symptoms including ear pain, hearing loss, tinnitus, and discharge. Complications from untreated perforations include recurrent infections and potential conductive hearing loss, making proper medical evaluation essential.
From the FDA Drug Label
Chronic Suppurative Otitis Media with perforated tympanic membranes 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.
The ofloxacin (OTIC) solution can be used to treat chronic suppurative otitis media with perforated tympanic membranes in patients 12 years and older, with a recommended dosage of ten drops instilled into the affected ear twice daily for fourteen days 2.
From the Research
Causes and Symptoms of Perforated Tympanic Membrane
- Tympanic membrane perforation may be caused by trauma or acute or chronic middle ear infection 3
- Perforation causes conductive hearing loss 3
- It is essential to keep the ear dry to prevent infections 3
Treatment and Management
- Most traumatic perforations heal spontaneously 3
- Perforations caused by acute middle ear infections are treated with antibiotics 3
- Chronic perforation due to chronic middle ear infection or cholesteatoma will usually not heal without surgery 3
- Ofloxacin ear drops can be effective in reducing healing time and increasing the rate of tympanic membrane perforation closure 4
- Ciprofloxacin/dexamethasone can delay healing of experimental tympanic membrane perforations 5, 6
Referral and Consultation
- Most perforation cases can be taken care of in primary care 3, 7
- ENT consultation is needed when alarming signs, such as continuous pain, vertigo, or facial paralysis exist, or if the perforation persists 3
- Indications for surgical repair include chronic perforation, cholesteatoma, or other complications 7