From the Guidelines
The most effective treatment for a discharging ear with a ruptured eardrum is topical quinolone antibiotics, which have been shown to be more effective than no drug treatment, topical antiseptics, and systemic antibiotics in clearing the discharge in the short term. When managing a discharging ear with a ruptured eardrum, it's crucial to prioritize measures that promote healing and prevent infection.
Key Considerations
- Keeping the ear dry is essential to prevent further infection and promote healing. This can be achieved by using earplugs or a cotton ball coated with petroleum jelly when showering and avoiding swimming until the ear has healed.
- Topical quinolone antibiotics, as mentioned, are the preferred treatment for clearing aural discharge associated with chronic suppurative otitis media (CSOM) 1.
- The use of systemic antibiotics may be considered in cases of severe infection, but evidence suggests that topical antibiotics alone are often sufficient, and combining them with systemic antibiotics does not necessarily improve outcomes 1.
- Pain management can be achieved with over-the-counter medications such as acetaminophen or ibuprofen.
- Most perforations heal spontaneously within 1-3 months, but larger tears may require surgical repair (tympanoplasty) if they do not close on their own after 3-6 months.
Treatment Approach
- Topical quinolone antibiotics should be the first line of treatment for a discharging ear with a ruptured eardrum, given their effectiveness and non-ototoxic nature 1.
- Regular follow-up with a healthcare provider is necessary to monitor the healing progress and adjust the treatment plan as needed. If symptoms worsen, fever develops, or discharge continues beyond 10-14 days of treatment, immediate follow-up is required.
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.
The solution should be warmed by holding the bottle in the hand for one or two minutes to avoid dizziness that may result from the instillation of a cold solution. The patient should lie with the affected ear upward, before instilling the drops The tragus should then be pumped 4 times by pushing inward to facilitate penetration into the middle ear. This position should be maintained for five minutes.
The treatment for a discharging ear with a ruptured eardrum (tympanic membrane perforation) is ofloxacin (OTIC). The recommended dosage is ten drops (0.5 mL, 1.5 mg ofloxacin) instilled into the affected ear twice daily for fourteen days 2.
- Key points:
- Warm the solution before instillation
- Instill the drops with the affected ear upward
- Pump the tragus 4 times to facilitate penetration into the middle ear
- Maintain the position for 5 minutes after instillation
From the Research
Treatment for Discharging Ear with Ruptured Eardrum
- The treatment for a discharging ear with a ruptured eardrum (tympanic membrane perforation) may involve the use of topical antibiotics, such as quinolone antibiotics, which have been shown to be effective in clearing aural discharge 3, 4.
- Topical antiseptics may also be used, but their effectiveness is less clear compared to quinolone antibiotics 3, 4.
- Systemic antibiotics may be used in some cases, but their use is generally reserved for more severe infections or when topical treatments are not effective 5, 3.
- In some cases, surgical intervention may be necessary to repair the ruptured eardrum or to treat underlying conditions such as chronic suppurative otitis media 5, 6.
Management of Underlying Conditions
- It is essential to manage underlying conditions that may be contributing to the discharge and ruptured eardrum, such as otitis externa, otitis media, or mastoiditis 5, 3.
- Treatment of these conditions may involve the use of topical or systemic antibiotics, as well as other medications to manage symptoms and prevent complications 5, 3.
Prevention of Further Complications
- To prevent further complications, it is essential to avoid inserting objects into the ear canal, such as cotton swabs, and to avoid swimming in polluted waters 6, 7.
- Regular cleaning of the ear canal and the use of ear protection when engaging in activities that may expose the ear to water or other irritants can also help to prevent further complications 6, 7.