What is the treatment for a complete tympanic membrane rupture?

Treatment for Complete Tympanic Membrane Rupture

For complete tympanic membrane rupture, the recommended treatment is conservative management with topical fluoroquinolone antibiotic ear drops (such as ofloxacin or ciprofloxacin-dexamethasone) and close follow-up, as most perforations will heal spontaneously within 1-3 months. 1

Initial Management

• Avoid irrigation of the ear canal in patients with perforated tympanic membranes as this can introduce bacteria into the middle ear and cause infection 2, 1
• Keep the ear dry by avoiding water entry into the ear canal:
  • Use earplugs or petroleum jelly-coated cotton when showering
  • Avoid swimming until cleared by a physician 1
• Avoid touching or scratching the ear to prevent further damage or infection 1

Antibiotic Treatment

For perforations with discharge/infection:

• First-line treatment: Topical fluoroquinolone antibiotic ear drops 1, 3

  • For patients 12 years and older: Ten drops (0.5 mL) of ofloxacin instilled into the affected ear twice daily for fourteen days 3
  • For children (1-12 years): Five drops (0.25 mL) instilled into the affected ear twice daily for ten days 3

• Application technique:

  • Warm the solution by holding the bottle in hand for 1-2 minutes
  • Patient should lie with affected ear upward
  • Pump the tragus 4 times after instillation to facilitate penetration into the middle ear
  • Maintain position for 5 minutes 3

Important precautions:

• Avoid aminoglycoside-containing drops as they can be ototoxic and cause permanent hearing loss 2, 1
• Avoid alcohol-containing solutions as they can be painful and potentially ototoxic 1
• Avoid unnecessary steroid-containing drops as they may delay healing 1

Pain Management

• Assess pain level and provide appropriate analgesia:
  • Mild to moderate pain: Acetaminophen or NSAIDs
  • Severe pain: Combination analgesics 1

Follow-Up and Monitoring

• Patients should be examined within 3 months of initial diagnosis 1
• Follow-up periodically until complete healing occurs 1
• Audiometric testing should be performed at least 6 weeks after initial diagnosis to assess hearing 1

Spontaneous Healing vs. Surgical Intervention

• Most tympanic membrane perforations (approximately 48-90%) heal spontaneously within 1-3 months 4, 5
• All children typically demonstrate complete spontaneous recovery 4
• Surgical intervention (tympanoplasty) may be necessary for:
  • Perforations that do not heal within 3 months
  • Large perforations (>50% of the tympanic membrane)
  • Perforations with significant hearing loss
  • Chronic perforations 1, 5

Referral to Otolaryngologist

Refer to an otolaryngologist for:

• Perforations that do not heal within 3 months
• Traumatic perforations with vertigo or significant hearing loss (>30 dB)
• Chronic perforations
• Suspected ossicular chain disruption
• Cholesteatoma (unsafe perforation)
• Patients with comorbidities (diabetes, immunocompromised states) 1, 6

Common Pitfalls to Avoid

1. Using irrigation for cleaning the ear canal in patients with perforated eardrums
2. Prescribing aminoglycoside-containing ear drops which can cause permanent hearing loss
3. Failing to follow up to ensure complete healing
4. Delaying referral for perforations that don't heal within 3 months
5. Allowing water to enter the ear canal before complete healing

Remember that most complete tympanic membrane perforations will heal spontaneously with proper care and protection from water and infection.