What is the treatment for chronic tympanic membrane perforation?

Treatment for Chronic Tympanic Membrane Perforation

For chronic tympanic membrane perforations, surgical repair through tympanoplasty is the definitive treatment, with specific medication management for associated infections based on FDA guidelines. 1

Initial Assessment and Management

• Keep the ear dry to prevent infection while awaiting definitive treatment 2, 3
• Avoid irrigation and pneumatic otoscopy as these can worsen the perforation or introduce infection 2
• Carefully suction any blood, purulent secretions, or debris from the ear canal 2

Medical Management

For perforations with active infection:

• For patients 12 years and older with chronic suppurative otitis media and perforated tympanic membranes:
  • Ten drops (0.5 mL, 1.5 mg ofloxacin) instilled into the affected ear twice daily for fourteen days 1
  • Proper administration technique:
    • Warm solution by holding bottle in hand for 1-2 minutes
    • Position patient with affected ear upward
    • Pump the tragus 4 times after instillation to facilitate penetration
    • Maintain position for 5 minutes 1

Surgical Management

Most chronic perforations will not heal without surgical intervention 3. Surgical options include:

1. Tympanoplasty - primary surgical approach for chronic perforations

   • Uses various graft materials including autologous fascia, cartilage, fat, or perichondrium 4
   • Success rates vary based on perforation size, location, and surgical technique

2. Myringoplasty - for smaller perforations

3. Tympanoplasty with ossicular chain reconstruction - when ossicular damage is present

Special Considerations

• Hearing assessment is essential as perforations typically cause conductive hearing loss 2, 3

  • Hearing loss >30 dB suggests ossicular chain disruption 2

• Potential complications of surgical repair include:

  • Prosthesis displacement (can occur weeks to months after surgery)
  • Ossicular chain disruption (occurs in ~3.6% of cases)
  • Tympanic membrane re-perforation (1-4.2% depending on technique)
  • Conductive hearing loss requiring revision (1.8-11% of cases) 5

• Risk factors for surgical failure include:

  • Previous failed tympanoplasty
  • Large perforations
  • Eustachian tube dysfunction 5

Referral Guidelines

ENT consultation is necessary when:

• Perforation persists despite treatment
• Alarming signs present (continuous pain, vertigo, facial paralysis)
• Significant hearing loss is present
• Chronic otitis media or cholesteatoma is suspected 3

Emerging Approaches

Tissue engineering approaches are being developed that may eventually provide alternatives to traditional surgical repair, including:

• Biocompatible scaffolds that mimic tympanic membrane structure
• Biomolecules to enhance healing
• Cellular therapies 4

These approaches aim to develop procedures that can be performed in outpatient settings with reduced surgical time and cost 4.