Is it safe for a patient with a perforated tympanic membrane to blow their nose?

Management of Patients with Perforated Tympanic Membrane: Nose Blowing Precautions

Patients with perforated tympanic membranes should avoid blowing their nose, as this can create sudden pressure changes that may introduce pathogens into the middle ear, delay healing, or worsen the perforation. 1

Rationale for Avoiding Nose Blowing

• Nose blowing creates sudden pressure changes that can:
  • Force bacteria and debris from the nasopharynx into the middle ear through the Eustachian tube
  • Disrupt the healing process of the perforation
  • Potentially enlarge existing perforations
  • Increase risk of middle ear infections

Recommended Patient Instructions

For patients with perforated tympanic membranes, advise the following:

• Keep the ear dry by avoiding water entry into the ear canal 1, 2
• Avoid activities that create pressure changes, including:
  • Nose blowing (if unavoidable, do it gently with mouth open) 3
  • Using straws for drinking 3
  • Air travel (if necessary, use decongestants before flying) 3
  • Vigorous exercise or heavy lifting that might increase intracranial pressure

Management of Sneezing

If a patient needs to sneeze:

• Sneeze with the mouth open to reduce pressure directed toward the Eustachian tubes 3
• Avoid pinching the nose closed during sneezing

Duration of Precautions

• These precautions should be maintained until the perforation has healed
• Most traumatic perforations heal spontaneously within 2-3 weeks 1
• Complete resolution may take up to 3 months in some cases 1
• Follow-up with a healthcare provider is recommended to confirm healing 1

Additional Care Instructions

• Use prescribed antibiotic drops if infection is present (fluoroquinolone drops are preferred as they are non-ototoxic) 1
• Avoid inserting anything into the ear canal, including cotton swabs
• Use earplugs or petroleum jelly-coated cotton when showering 1
• Avoid swimming until cleared by a physician 1

When to Seek Medical Attention

Patients should seek immediate medical attention if they experience:

• Increased pain or discharge from the ear
• New onset of dizziness or vertigo
• Sudden hearing loss
• Fever or other signs of infection

Following these precautions will help promote healing of the perforated tympanic membrane and reduce the risk of complications such as chronic infection or hearing loss.