From the Guidelines
A ruptured tympanic membrane following acute otitis media can lead to complications such as infection, pain, or ototoxic hearing loss, and therefore, requires careful management to prevent these consequences. The management of a ruptured eardrum should prioritize preventing further complications and promoting healing.
Key Considerations
- The presence of a nonintact tympanic membrane may be assessed by history and/or physical examination 1.
- Depending on the irrigation solution used, infection, pain, or ototoxic hearing loss could result, and use of irrigation in the presence of a perforated tympanic membrane could produce caloric effects resulting in vertigo 1.
- Mechanical removal of cerumen is the preferred technique when the ear drum is not intact 1.
Management
- Keep the ear dry by using earplugs or cotton balls coated with petroleum jelly when showering, and avoid swimming until healing is complete.
- Pain can be managed with over-the-counter medications like acetaminophen (Tylenol) 500-1000mg every 6 hours or ibuprofen (Advil, Motrin) 400-600mg every 6-8 hours as needed.
- If the rupture occurred due to an active infection, antibiotic ear drops such as ofloxacin (Floxin Otic) or ciprofloxacin with dexamethasone (Ciprodex) may be prescribed.
- Seek immediate medical attention if you experience severe pain, dizziness, facial weakness, or persistent drainage from the ear.
Potential Outcomes
- Most perforations heal spontaneously as the eardrum has excellent blood supply and regenerative capacity.
- Large or persistent perforations may require surgical repair (tympanoplasty) if they don't heal within 3 months.
From the Research
Consequences of a Ruptured Tympanic Membrane
The consequences of a ruptured tympanic membrane (eardrum) following acute otitis media (middle ear infection) include:
- Conductive hearing loss, as stated in the study 2
- Aural fullness and mild tinnitus, as mentioned in the study 3
- Infections, which can be predisposed by the perforation, emphasizing the importance of keeping the ear dry 2, 3
- Potential disruption of the ossicular chain, suggested by symptoms such as vertigo, nausea, and vomiting, and an audiogram showing a conductive hearing loss of more than 30 dB 3
- Possible inner ear nerve damage, indicated by profound sensorineural loss 3
Treatment and Management
Treatment for a ruptured tympanic membrane due to acute otitis media may involve:
- Oral and topical antibiotics, as prescribed for perforations related to acute otitis media 3
- Keeping the affected ear dry to prevent further infection 2, 3
- Suctioning out blood, purulent secretions, and other debris from the canal, while avoiding irrigation and pneumatic otoscopy 3
- Potential otolaryngologic referral for evaluation of traumatic perforations associated with vertigo or significant hearing loss, or for perforations that do not heal within one month 3