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

Treatment of a Ruptured Ear Drum (Tympanic Membrane Perforation)

Most tympanic membrane perforations heal spontaneously within 2-3 weeks with appropriate management, which should include topical non-ototoxic fluoroquinolone drops (e.g., ofloxacin), keeping the ear dry, and adequate pain control. 1

Initial Management

Pain Control

• Assess pain level and provide appropriate analgesia:
  • Mild to moderate pain: Acetaminophen or NSAIDs
  • Severe pain: Consider combination analgesics with opioids 1

Antibiotic Therapy

• Topical antibiotics are preferred over systemic antibiotics for perforations 1
• For chronic suppurative otitis media with perforated tympanic membranes:
  • Apply 10 drops (0.5 mL, 1.5 mg ofloxacin) into the affected ear twice daily for fourteen days 2
• Application technique:
  1. Warm the solution by holding the bottle in hand for 1-2 minutes
  2. Position patient with affected ear upward
  3. Instill drops
  4. Pump the tragus 4 times to facilitate penetration
  5. Maintain position for 5 minutes 2

Ear Protection

• Keep the ear dry to prevent infection:
  • Avoid water entry
  • Use earplugs or petroleum jelly-coated cotton when showering
  • Avoid swimming until cleared by a physician 1

Follow-up and Monitoring

• Re-evaluation within 48-72 hours if symptoms don't improve 1
• Follow-up within 3 months to assess healing 1
• Comprehensive audiologic examination is recommended as symptoms are likely associated with hearing difficulties 1

Prognosis and Healing

• Healing rates by timeframe:
  • 2 weeks: 30-40% resolution
  • 1 month: 60-70% resolution
  • 3 months: 75-90% resolution 1
• Smaller perforations heal faster than larger ones 1
• Research shows that moist environments from topical application of ofloxacin drops can shorten closure time and improve closure rates for large traumatic perforations 3

Referral Criteria

Refer to an otolaryngologist if:

• Perforation fails to heal after 3 months of observation
• Significant hearing loss (>30 dB conductive loss) is present
• Traumatic perforations with vertigo
• Suspected ossicular chain disruption
• Cholesteatoma is present 1

Special Considerations

• Patients with diabetes are at higher risk of malignant otitis externa and require closer monitoring 1
• Children, especially those under 2, may take longer to clear effusions 1
• Avoid using potentially ototoxic drops (containing aminoglycosides) as they can cause permanent hearing loss 1
• Research shows that 99.1% of traumatic perforations can be successfully treated with micropore tape patching in select cases 4
• Studies indicate that most traumatic perforations (especially in children) heal spontaneously with conservative management 5

Potential Complications

• Hearing loss
• Chronic suppurative otitis media
• Cholesteatoma formation
• Ototoxicity if inappropriate drops are used 1

Remember that the size and location of the perforation influence healing time, with anterior-inferior quadrant perforations typically having a more favorable course than posterior-superior perforations 6.