What do you do for a ruptured eardrum?

Management of Ruptured Eardrum

For a ruptured eardrum (tympanic membrane perforation), most cases will heal spontaneously within 1-3 months with proper care and protection from water and infection.

Initial Assessment and Management

1. Determine the cause and extent of perforation

   • Trauma (cotton swabs, foreign objects)
   • Infection (middle ear infection)
   • Barotrauma (pressure changes during flying, diving)
   • Blast injuries

2. Immediate care measures:

   • Keep the ear dry
   • Avoid inserting anything into the ear canal
   • Avoid swimming and submerging head underwater
   • Cover the ear canal with cotton saturated with petroleum jelly during bathing/showering

Treatment Algorithm

For Uncomplicated Perforations:

1. Watchful waiting is appropriate for most small to medium-sized perforations

   • Most perforations heal spontaneously within 1-3 months
   • Regular follow-up every 4-6 weeks to monitor healing

2. Pain management

   • Over-the-counter pain relievers as needed
   • Avoid pain-relieving (anesthetic) eardrops as they can mask symptoms

3. Prevention of infection

   • Keep water out of the ear
   • Avoid cleaning the ear yourself as it can damage the healing eardrum

For Perforations with Drainage/Infection:

1. Antibiotic eardrops (if drainage is present)

   • Quinolone eardrops (ofloxacin or ciprofloxacin) are preferred as they:
     • Have no ototoxicity risk if they enter the middle ear
     • Deliver high antibiotic concentrations directly to the site
     • Avoid systemic side effects 1

2. Administration of eardrops:

   • Have someone else place drops if possible
   • Lie with affected ear up
   • Fill ear canal with prescribed drops
   • Remain in position for 3-5 minutes
   • Pump the tragus (flap of skin in front of ear canal) 4 times to help drops enter 2

3. Cleaning the ear canal:

   • Remove drainage with cotton-tipped swab dipped in hydrogen peroxide or warm water
   • Or gently suction with infant nasal aspirator 2

When to Seek Medical Attention:

1. Immediate medical attention if:

   • Severe pain, bleeding, or hearing loss
   • Dizziness or vertigo
   • Facial weakness
   • High fever

2. Follow-up medical care if:

   • Symptoms persist beyond 7 days
   • Drainage continues despite treatment
   • No improvement in hearing after 1-2 months

Special Considerations

Water Precautions

• Avoid water exposure until the perforation heals
• Use ear plugs or cotton with petroleum jelly when showering
• No swimming until healing is complete 2

Contraindicated Practices

• Do not use cotton-tipped swabs to clean the ear canal as they can cause further damage 2
• Do not use ear candling/coning as it is ineffective and potentially dangerous 2
• Avoid solutions containing alcohol in patients with tympanic membrane perforation, as alcohol in the middle ear is painful and potentially ototoxic 1

Surgical Management

Consider referral for surgical repair (tympanoplasty) if:

• Perforation does not heal spontaneously after 3 months
• Large perforation unlikely to heal on its own
• Recurrent or chronic infections
• Significant hearing loss due to the perforation

Prevention of Future Perforations

1. Avoid inserting objects into the ear canal, including cotton swabs
2. Proper management of ear infections
3. Use of pressure-equalizing techniques during air travel or diving
4. Protection from loud noises and blast injuries

By following these guidelines, most eardrum perforations will heal without complications, preserving hearing and preventing chronic problems.