From the Guidelines
The treatment for a discharging ear with a ruptured tympanic membrane should prioritize the use of non-ototoxic topical preparations, as recommended by the clinical practice guideline for acute otitis externa 1. When managing a discharging ear with a ruptured tympanic membrane, it is crucial to keep the ear dry to prevent further infection. This can be achieved by using earplugs or cotton balls coated with petroleum jelly during showers and avoiding swimming until the ear has healed. For antibiotic treatment, fluoroquinolone ear drops such as ciprofloxacin (Ciprodex) or ofloxacin are typically prescribed, usually 3-4 drops in the affected ear twice daily for 7-10 days, as they help clear the infection while avoiding ototoxicity 1. Some key considerations include:
- Avoiding the use of ototoxic medications to prevent further damage to the ear
- Managing pain with acetaminophen or ibuprofen as needed
- Keeping the ear clean by gently wiping the outer ear, but never inserting cotton swabs or other objects into the ear canal
- Following up with a healthcare provider to ensure proper healing and to address any complications Most tympanic membrane perforations heal spontaneously within 1-2 months, but persistent perforations (beyond 3 months) may require surgical repair through tympanoplasty 1.
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 tympanic membrane 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 for patients 12 years and older 2.
- Key points:
- Warm the solution before instillation
- Instill 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 Tympanic Membrane
The treatment for a discharging ear with a ruptured tympanic membrane typically involves the use of antibiotics to manage the infection.
- Ofloxacin otic solution 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, 4.
- The use of ofloxacin otic solution has been compared to other treatments, such as oral amoxicillin/clavulanic acid, and has been found to be as effective or more effective in some cases 3.
- It is also important to note that the treatment of a discharging ear with a ruptured tympanic membrane should be done under the guidance of a healthcare professional, as improper treatment can lead to further complications.
Considerations for Treatment
When treating a discharging ear with a ruptured tympanic membrane, it is essential to consider the following:
- The use of antimycotic therapy may be necessary in cases of otomycosis, which can occur after prolonged antibiotic ototopic therapy 5.
- The effects of different antibiotics on tympanic membrane healing should be considered, as some antibiotics, such as ciprofloxacin/dexamethasone, may delay healing 6.
- The duration of antibiotic treatment is crucial, and it is recommended to continue treatment for 8-10 days, depending on the presence of spontaneous perforation 7.
Antibiotic Treatment Options
The following antibiotic treatment options may be considered for a discharging ear with a ruptured tympanic membrane: