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

Management of Ruptured Tympanic Membrane

Most ruptured tympanic membranes heal spontaneously with conservative management, which includes keeping the ear dry, avoiding water entry, and monitoring for complications. 1, 2, 3

Initial Management

Assessment and Conservative Care

• Keep the ear dry - Instruct patients to avoid water entry into the ear canal 1
• Avoid activities that create pressure changes 1:
  • Forceful nose blowing
  • Using straws for drinking
  • Air travel if possible
  • Vigorous exercise or heavy lifting

Pain Management

• Acetaminophen or NSAIDs for mild to moderate pain
• Combination analgesics with opioids may be necessary for severe pain 1

Infection Prevention and Treatment

• For perforations with signs of infection:
  • Use non-ototoxic topical fluoroquinolone drops (e.g., ofloxacin 0.3%) at a dosage of ten drops twice daily for 14 days 1
  • Avoid ototoxic topical preparations to prevent hearing loss and balance disturbance 1
  • If associated with acute otitis media, treat with appropriate antibiotics 1

Special Considerations

• Do not perform ear syringing in patients with perforated tympanic membranes 4
• For fungal infections (otomycosis), topical antifungal therapy such as clotrimazole solution is appropriate 1
• Patients with diabetes require closer monitoring due to higher risk of malignant otitis externa 4, 1

Monitoring and Follow-up

• Schedule follow-up within 3 months to assess healing 1
• Obtain audiometric testing at least 6 weeks after initial diagnosis 1
• Monitor for signs of serious complications requiring immediate attention 1:
  • Increasing pain
  • Fever
  • Spreading redness
  • Facial weakness

Expected Outcomes

• 95% of traumatic perforations heal spontaneously with conservative management 3
• Children typically demonstrate complete spontaneous recovery 5
• Middle ear effusion resolution rates 1:
  • 2 weeks: 30-40%
  • 1 month: 60-70%
  • 3 months: 75-90%

Indications for Specialist Referral

Refer to an otolaryngologist if 1, 6:

• Perforation fails to heal after 3 months of observation
• Significant hearing loss (>30 dB conductive loss) is present
• Persistent symptoms such as vertigo, continuous pain, or facial paralysis exist
• Chronic perforation due to chronic middle ear infection or cholesteatoma is suspected

Surgical Management

Tympanoplasty may be recommended for 1:

• Persistent tympanic membrane perforation
• Recurrent ear infections
• Moderate to severe mixed hearing loss

Common Pitfalls to Avoid

1. Using ototoxic ear drops - Can cause hearing loss and balance disturbance 1
2. Performing ear irrigation - Can worsen perforation or cause infection 4
3. Ignoring persistent symptoms - Vertigo, significant hearing loss, or facial paralysis require specialist evaluation 2, 6
4. Neglecting follow-up - Perforations that don't heal may require surgical intervention 1
5. Allowing water entry - Patients should use earplugs or petroleum jelly-coated cotton when showering 1