What is the treatment for a ruptured eardrum (tympanic membrane perforation)?

From the Guidelines

Treatment for a ruptured eardrum typically involves allowing the eardrum to heal on its own while preventing infection and managing pain. Most perforations heal naturally within 1-3 months without surgical intervention. To manage the condition, it is essential to keep the ear dry by placing a cotton ball coated with petroleum jelly in the outer ear when showering or bathing, and avoid swimming until healing is complete. For pain management, over-the-counter analgesics like acetaminophen (325-650mg every 4-6 hours) or ibuprofen (400-600mg every 6-8 hours) are usually sufficient. If infection is present or suspected, antibiotic ear drops may be prescribed, however, the specific type and dosage should be determined by a healthcare professional. It is crucial to avoid inserting anything into the ear canal, including cotton swabs, as this can push the cerumen further into the ear and potentially damage the eardrum or middle ear structures, as noted in the context of cerumen impaction management 1. For large perforations or those that don't heal within 3-6 months, surgical repair (tympanoplasty) may be necessary. The eardrum serves as protection for the middle ear and helps with sound transmission, so proper healing is important to prevent hearing loss and recurrent infections. Key considerations include:

• Keeping the ear dry to prevent infection
• Managing pain with over-the-counter analgesics
• Avoiding insertion of objects into the ear canal
• Considering surgical repair for large or non-healing perforations.

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 ruptured eardrum (tympanic membrane perforation) with chronic suppurative otitis media is ofloxacin (OTIC), with a recommended dosage of 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 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 Options for Ruptured Eardrum

• The treatment for a ruptured eardrum (tympanic membrane perforation) can vary depending on the size and location of the perforation, as well as the presence of any underlying infections 3, 4, 5, 6, 7.
• Topical antibiotics, such as ofloxacin otic drops, may be used to promote healing and prevent infection 3, 4, 7.
• Studies have shown that ofloxacin otic drops can improve the closure rate and shorten the closure time of medium and large perforations 3.
• However, the use of ciprofloxacin/dexamethasone may delay healing of the tympanic membrane 5.
• Endoscopic tympanoplasty type I is a surgical procedure that can be used to repair perforations, especially those located in the anterior quadrants of the eardrum 6.
• The use of cartilage or cartilage and perichondrium as a graft material can improve the success rate of the surgery and lead to satisfactory hearing results 6.
• Preoperative topical ofloxacin solution may be used to eradicate middle ear pathogens and improve operative outcome, but its effectiveness in improving graft success rate is still unclear 7.

Considerations for Treatment

• The size and location of the perforation, as well as the presence of any underlying infections, should be taken into account when determining the best course of treatment 3, 4, 5, 6, 7.
• The patient's overall health and medical history should also be considered when selecting a treatment option.
• In some cases, a combination of topical antibiotics and surgical repair may be necessary to achieve optimal results 3, 4, 6, 7.