From the Guidelines
The treatment for a tympanic membrane (TM) perforation typically begins with watchful waiting, as most small perforations heal spontaneously within 1-3 months. During this period, it is essential to keep the ear dry by using earplugs or cotton balls coated with petroleum jelly when showering, and avoid swimming. If there's drainage, topical antibiotic drops like ofloxacin (5 drops twice daily for 7-10 days) or ciprofloxacin with dexamethasone may be prescribed to treat infection, as recommended by studies such as 1 and 1. For perforations that don't heal spontaneously after 3 months or for larger perforations, surgical repair called tympanoplasty may be necessary. This outpatient procedure uses tissue grafts to close the perforation and typically has a success rate of 85-90%. Surgical intervention is also indicated immediately for perforations caused by trauma with displaced ear bones or for those with persistent symptoms like hearing loss, tinnitus, or recurrent infections. The reason many perforations heal on their own is that the outer layer of the eardrum has remarkable migratory properties that allow epithelial cells to gradually close small to medium defects, while surgical repair becomes necessary when the perforation is too large for this natural process to be effective.
Some key considerations in managing TM perforations include:
- Keeping the ear dry to prevent infection
- Using topical antibiotic drops for drainage or infection
- Considering surgical repair for larger perforations or those that don't heal spontaneously
- Immediate surgical intervention for perforations caused by trauma or with persistent symptoms It's also important to note that patients with certain underlying conditions, such as diabetes or immunocompromised states, may require special consideration and management, as discussed in studies like 1. However, the primary approach to treating TM perforations remains watchful waiting and topical treatment, with surgical intervention as needed.
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 tympanic membrane (TM) perforation due to chronic suppurative otitis media is ofloxacin (OTIC), with a recommended dosage of 10 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 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 TM Perforation
The treatment for a tympanic membrane (TM) perforation depends on the cause and severity of the perforation.
- Most small perforations resolve spontaneously, and the affected ear should be kept dry 3, 4.
- Oral and topical antibiotics may be prescribed for perforations related to acute otitis media 3.
- For traumatic perforations, conservative follow-up until spontaneous complete recovery is the most common choice 5.
- In some cases, surgical intervention such as tympanoplasty may be necessary, especially for perforations that do not heal within one month or for those associated with vertigo or significant hearing loss 3, 5.
- Topical antimicrobial agents like ofloxacin otic solution can be effective in treating ear infections, including those with perforated tympanic membranes 6.
- For cases of otomycosis with TM perforation, proper medical treatment is usually effective, but in some cases, a tympanoplasty may be required 7.
Management of TM Perforation
- It is essential to carefully suction out blood, purulent secretions, and other debris from the canal, and to describe the perforation size and location 3.
- Irrigation and pneumatic otoscopy should be avoided 3.
- Mastoid radiographs and computed tomographic scans may be useful in cases of significant trauma and infection 3.
- Otolaryngologic referral may be necessary to evaluate traumatic perforations associated with vertigo or significant hearing loss, perforations from chronic otitis media, or perforations from acute otitis media that do not heal within one month 3, 4.