What is the plan of care for a ruptured tympanic membrane (TM) from diving?

From the Guidelines

The care plan for a ruptured tympanic membrane from diving should prioritize keeping the ear dry, avoiding further diving or swimming until healing is complete, and pain management with acetaminophen or ibuprofen as needed, as this approach is most likely to minimize morbidity, mortality, and improve quality of life. When managing a ruptured tympanic membrane from diving, it is essential to consider the following key points:

• Keeping the ear dry is crucial to prevent infection and promote healing, as emphasized in the context of managing acute otitis externa 1.
• Avoiding further diving or swimming until the tympanic membrane is fully healed (typically 4-6 weeks) is vital to prevent recurrence and potential complications.
• Pain management with acetaminophen (500-1000mg every 6 hours) or ibuprofen (400-600mg every 6-8 hours) as needed is recommended to ensure patient comfort and minimize distress.
• The ear canal should be kept clean and dry, and patients should avoid inserting anything into the ear to prevent infection and further damage.
• Antibiotic ear drops such as ofloxacin may be prescribed if there's evidence of infection, but oral antibiotics are generally unnecessary unless there's significant infection, as suggested by guidelines for managing acute otitis externa 1.
• Patients should seek immediate medical attention if they experience increased pain, discharge, hearing loss, dizziness, or fever, as these symptoms may indicate complications that require prompt intervention.
• Follow-up with a healthcare provider is recommended after 1-2 weeks to assess healing and provide ongoing care, which is in line with the emphasis on regular follow-up in managing chronic otitis media with effusion 1.

From the Research

Plan of Care for Ruptured Tympanic Membrane (TM) from Diving

The plan of care for a ruptured TM from diving involves several key steps:

• Keeping the affected ear dry to prevent infection 2
• Avoiding irrigation and pneumatic otoscopy 2
• Carefully suctioning out blood, purulent secretions, and other debris from the canal 2
• Describing the perforation size and location 2
• Considering oral and topical antibiotics for perforations related to acute otitis media 2
• Referring the patient to an otolaryngologist if necessary, especially for traumatic perforations associated with vertigo or significant hearing loss 2, 3

Conservative Management

Conservative management is often the primary approach for ruptured TM from diving:

• Most small perforations resolve spontaneously 2
• The use of ofloxacin otic drops has been shown to shorten the closure time and improve the closure rate of traumatic TM perforations, especially for large perforations 4, 5
• A systematic review and meta-analysis found that ofloxacin ear drops are effective in reducing healing time and increasing the rate of TM perforation closure, with no evidence of increased risk of hearing loss or infection rates 5

Referral to an Otolaryngologist

Referral to an otolaryngologist may be necessary for:

• Traumatic perforations associated with vertigo or significant hearing loss 2
• Perforations from chronic otitis media or acute otitis media that do not heal within one month 2
• Cases of significant trauma and infection, where mastoid radiographs and computed tomographic scans may be useful 2