From the Guidelines
A perforated tympanic membrane (eardrum) typically heals on its own within 1-3 months without intervention, and the primary treatment focus should be on managing symptoms and preventing complications, as recommended by the most recent guidelines 1. To manage symptoms and prevent complications, consider the following:
- Keep the ear dry by avoiding swimming and using earplugs or cotton balls coated with petroleum jelly during showers.
- Pain can be managed with acetaminophen (500-1000mg every 6 hours) or ibuprofen (400-600mg every 6-8 hours).
- Avoid inserting anything into the ear canal, including cotton swabs.
- If discharge occurs, your doctor may prescribe antibiotic ear drops such as ofloxacin (5 drops twice daily for 7-10 days), taking into account the potential risks of ototoxicity, especially with prolonged or repetitive administration 1. Some key considerations in managing a perforated tympanic membrane include:
- Careful examination of the tympanic membrane to confirm the presence of a perforation, which may be suspected based on prior history or symptoms 1.
- The use of a wick to promote drug delivery, especially in cases with edema preventing drop entry or limited visualization of the tympanic membrane, although the benefit of a wick is not universally established 1.
- Monitoring for signs of complications, such as severe pain, persistent discharge, hearing loss, or dizziness, which may require prompt medical attention. The clinician should prescribe a non-ototoxic topical preparation when a perforation of the tympanic membrane is known or suspected, as recommended by recent guidelines 1. In cases where the perforation does not heal spontaneously within 3 months, or if large perforations are present, surgical repair (tympanoplasty) may be necessary to prevent long-term complications such as hearing loss or middle ear infections.
From the FDA Drug Label
Chronic Suppurative Otitis Media with perforated tympanic membranes The recommended dosage regimen for the treatment of chronic suppurative otitis media with perforated tympanic membranes in patients 12 years and older is: Ten drops (0.5 mL, 1. 5 mg ofloxacin) instilled into the affected ear twice daily for fourteen days.
The symptoms of a perforated tympanic membrane are not directly mentioned in the label.
- The treatment option for Chronic Suppurative Otitis Media with perforated tympanic membranes is ofloxacin (OTIC), with a recommended dosage of ten drops (0.5 mL, 1.5 mg ofloxacin) instilled into the affected ear twice daily for fourteen days 2.
From the Research
Symptoms of a Perforated Tympanic Membrane
- Conductive hearing loss [(3,4,5)]
- Aural fullness [(3,4,6)]
- Mild tinnitus [(3,4,6)]
- Autophonia 6
- Ear fullness 6
- Vertigo, nausea, and vomiting (in cases of disruption of the ossicular chain) 3
- Profound sensorineural loss (in cases of inner ear nerve damage) 3
Treatment Options
- Keeping the affected ear dry [(3,4)]
- Oral and topical antibiotics for perforations related to acute otitis media 3
- Surgical repair for chronic perforations due to chronic middle ear infection or cholesteatoma [(4,5)]
- Use of bacterial cellulose film to alleviate symptoms and accelerate the healing process 6
- Otolaryngologic referral for traumatic perforations associated with vertigo or significant hearing loss, perforations from chronic otitis media, or perforations from acute otitis media that do not heal within one month [(3,7)]
- Conservative care for most cases, with referral to an otolaryngologist only when necessary 7