What is the recommended treatment for a ruptured tympanic membrane?

From the Guidelines

The recommended treatment for a ruptured tympanic membrane is to prescribe a non-ototoxic topical preparation, as stated in the clinical practice guideline for acute otitis externa 1. When managing a ruptured tympanic membrane, it is crucial to consider the risk of infection and the potential for spontaneous healing.

• The patient should keep the ear dry by using a cotton ball coated with petroleum jelly during showers and avoid swimming until healing is complete.
• Pain management can be achieved with over-the-counter analgesics like acetaminophen or ibuprofen.
• If discharge is present, antibiotic ear drops may be prescribed to prevent infection, but oral antibiotics are generally not necessary unless there is evidence of middle ear infection.
• It is essential to avoid inserting objects into the ear canal and refrain from forceful nose blowing, which can disrupt the healing process. The guideline recommends a non-ototoxic topical preparation for patients with a known or suspected perforation of the tympanic membrane, including those with a tympanostomy tube, based on reasoning from first principles and exceptional circumstances where validating studies cannot be performed, with a preponderance of benefit over harm 1.
• The quality of evidence for this recommendation is Grade C, based on outcomes from individual treatment arms of randomized controlled trials of efficacy of topical therapy for acute otitis externa.
• The level of confidence in the evidence is medium, as most randomized trials have been conducted in specialist settings, and the generalizability to primary care settings is unknown 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 recommended treatment for a ruptured tympanic membrane (also referred to as a perforated tympanic membrane) is:

• Ofloxacin (OTIC): 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 by holding the bottle in the hand for one or two minutes to avoid dizziness.
• Lie with the affected ear upward before instilling the drops.
• Pump the tragus 4 times by pushing inward to facilitate penetration into the middle ear.
• Maintain the position for five minutes after instillation.

From the Research

Treatment Options for Ruptured Tympanic Membrane

The recommended treatment for a ruptured tympanic membrane includes:

• Ofloxacin otic solution: Studies have shown that ofloxacin otic solution is effective in treating traumatic large tympanic membrane perforations 3, 4, 5, 6.
• Gelatin sponge patching: Gelatin sponge patching has also been found to be an effective treatment strategy for traumatic large tympanic membrane perforations 3.
• Spontaneous healing: Some studies have found that spontaneous healing can occur in patients with traumatic tympanic membrane perforations, although the healing time may be longer compared to treatment with ofloxacin otic solution or gelatin sponge patching 3, 5.

Comparison of Treatment Outcomes

Comparing the outcomes of different treatment options:

• Ofloxacin otic solution has been found to have a higher closure rate and shorter healing time compared to spontaneous healing 3, 5, 6.
• Gelatin sponge patching has also been found to have a higher closure rate compared to spontaneous healing, although the healing time may be longer compared to ofloxacin otic solution 3.
• Ciprofloxacin/dexamethasone has been found to delay healing of experimental tympanic membrane perforations, although the brief exposure in the study did not cause persistent perforations 7.

Considerations for Treatment

Considerations for treatment include:

• The size and location of the perforation: Larger perforations may require more aggressive treatment, such as gelatin sponge patching or ofloxacin otic solution 3, 5.
• The presence of infection: Ofloxacin otic solution has been found to be effective in treating infections of the ear, including those with perforated tympanic membranes 4.
• The patient's overall health: Patients with certain medical conditions, such as severe otologic disease or craniocerebral injury, may require more careful consideration and monitoring during treatment 6.