What treatment should be prescribed for a 54-year-old male with ear pain and tenderness after a Q-tip (cotton swab) injury to the eardrum without perforation?

Treatment for Q-tip Injury to the Ear Without Perforation

For a 54-year-old male with ear pain and tenderness after a Q-tip injury to the eardrum without perforation, analgesic treatment with acetaminophen or nonsteroidal anti-inflammatory drugs is the most appropriate initial management.

Pain Management

Pain is a primary concern following ear canal trauma, and proper pain management is essential:

• Assess pain severity using appropriate scales (visual analog scale may be helpful for adults) 1
• For mild to moderate pain:
  • Acetaminophen or NSAIDs (such as ibuprofen) are first-line options
  • These can be given alone or in fixed combination with an opioid if pain is more severe 1
  • NSAIDs have been shown to significantly reduce pain compared to placebo in ear canal inflammation 1
• Administer analgesics at regular intervals rather than as needed (prn) for more effective pain control 1

Topical Treatment Considerations

While the patient does not have a perforation, there may be inflammation or minor trauma to the ear canal that requires attention:

• Avoid inserting anything into the ear canal, including cotton-tipped swabs, to prevent further injury 1
• If there is concern about external ear canal inflammation:
  • Consider topical antibiotic drops only if signs of infection develop
  • Fluoroquinolone drops (ciprofloxacin or ofloxacin) would be appropriate if infection is suspected 1

Prevention of Complications

To prevent complications and promote healing:

• Cover the opening of ear canal with an earplug or cotton with petroleum jelly prior to showering or hair washing to minimize water entry 1
• Avoid swimming until symptoms resolve 1
• Monitor for signs of infection such as increased pain, drainage, or fever

Follow-up Recommendations

• If symptoms persist beyond 48-72 hours despite analgesic treatment, the patient should follow up for reassessment 1
• Most patients should feel better within 48 to 72 hours and have minimal or no symptoms by 7 days 1

Warning Signs Requiring Prompt Medical Attention

The patient should seek immediate medical attention if any of the following occur:

• Persistent or worsening pain despite analgesics
• Development of drainage from the ear
• Hearing loss
• Dizziness or vertigo
• Fever

Common Pitfalls to Avoid

1. Avoid topical anesthetic drops - These are not FDA-approved for safety and effectiveness and may mask symptoms of delayed response to therapy 1

2. Avoid ear candles - These have never been shown to be effective and can cause harm including hearing loss and tympanic membrane perforation 1

3. Avoid unnecessary oral antibiotics - Without signs of infection, systemic antibiotics are not indicated and may lead to antibiotic resistance 1

4. Avoid aggressive cleaning attempts - Further manipulation of the ear canal can cause additional trauma or push debris deeper 1