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

Treatment of Ruptured Eardrum with Drainage

For a ruptured eardrum (tympanic membrane perforation) with drainage, topical antibiotic eardrops are the first-line treatment, specifically ofloxacin or ciprofloxacin-dexamethasone drops, administered twice daily for 7-14 days. 1, 2

Initial Management

Assessment and Cleaning

1. Gently clean the ear canal to remove drainage and debris:
   • Use a cotton-tipped swab dipped in hydrogen peroxide or warm water 1
   • Alternatively, use tissue spears (twisted tissue paper) to absorb drainage 1
   • For significant drainage, gentle suction with an infant nasal aspirator may be helpful 1

Medication Administration

• For adults and children ≥13 years:

  • 10 drops (0.5 mL) of ofloxacin instilled into affected ear twice daily for 14 days 2

• For children (1-12 years):

  • 5 drops (0.25 mL) of ofloxacin instilled into affected ear twice daily for 10 days 2

Proper Administration Technique

1. Warm the solution by holding the bottle in hand for 1-2 minutes to prevent dizziness 2
2. Position patient with affected ear upward
3. Instill drops into ear canal
4. Pump the tragus (flap of skin in front of ear canal) 4 times to help drops penetrate 1, 2
5. Maintain position for 5 minutes 2

Special Considerations

For Severe Edema or Narrow Canal

• If ear canal edema prevents drop entry, a wick may be placed:
  • Use compressed cellulose wick (preferred) or ribbon gauze 1
  • Moisten the wick with drops to expand it and facilitate drug delivery 1
  • Remove once ear canal edema subsides (typically within 24-72 hours) 1

Precautions During Treatment

• Prevent water entry into ear canal during bathing/showering:
  • Use cotton saturated with petroleum jelly to cover ear canal opening 1
  • Avoid swimming until drainage stops 1
• Limit use of antibiotic eardrops to prescribed duration (typically 7-14 days) to prevent yeast infections 1

When to Consider Additional Treatment

• If drainage persists beyond 7 days despite appropriate topical therapy:

  • Consider culture of persistent drainage to identify resistant organisms or fungi 1
  • May need further cleaning of ear canal or suctioning to facilitate drug delivery 1

• Oral antibiotics should be considered only if:

  • Patient is very ill
  • Infection doesn't respond to topical therapy after 7-10 days
  • Patient has other conditions requiring systemic antibiotics 1

Follow-up Care

• Follow-up examination is recommended in 1-2 weeks to:

  • Confirm resolution of infection
  • Assess healing of tympanic membrane perforation
  • Most traumatic perforations heal spontaneously within 1-3 months 3, 4

• If perforation persists beyond 6 months, surgical repair (tympanoplasty) may be warranted 4

Common Pitfalls to Avoid

1. Using cotton balls as wicks - they can fall apart and be retained in the ear canal 1
2. Using oral antibiotics as first-line therapy - topical therapy is more effective and reduces risk of systemic side effects 1
3. Inadequate cleaning before drop administration - debris can block medication from reaching infection site 1
4. Improper drop administration technique - failure to pump the tragus reduces middle ear penetration 1, 2
5. Prolonged use of antibiotic drops - can lead to fungal superinfection of the ear canal 1

By following this treatment approach, most ruptured eardrums with drainage will resolve successfully with minimal complications and good healing outcomes.