Treatment for Bleeding Ear Drum (Tympanic Membrane Perforation)
For a bleeding ear drum (tympanic membrane perforation), keep the ear dry, avoid irrigation, and use non-ototoxic topical antibiotics like ofloxacin if infection is present. 1, 2
Initial Assessment and Management
- Confirm the diagnosis through careful otoscopic examination, noting the size and location of the perforation 1
- Assess for any modifying factors that may influence management, such as diabetes or immunocompromised state 1
- Carefully suction blood, purulent secretions, and debris from the ear canal to visualize the perforation 3
- Avoid irrigation and pneumatic otoscopy as these can worsen the perforation or introduce infection 1, 3
- Most small traumatic perforations heal spontaneously within 6-8 weeks 4, 5
Treatment Algorithm
Step 1: Ear Protection
- Keep the ear dry to prevent infection 1
- Instruct patients to use ear plugs or cotton balls coated with petroleum jelly when showering 1
- Advise against swimming until the perforation has healed completely 1
Step 2: Medication Management
- For infected perforations:
- Use only non-ototoxic topical antibiotics such as ofloxacin 2, 1
- For patients 12 years and older with chronic suppurative otitis media: Ten drops (0.5 mL) of ofloxacin instilled into the affected ear twice daily for fourteen days 6
- For pediatric patients with tympanostomy tubes: Five drops (0.25 mL) of ofloxacin instilled into the affected ear twice daily for ten days 6
- Avoid alcohol-containing drops or potentially ototoxic preparations that can enter the middle ear through the perforation 1
Step 3: Follow-up Care
- Monitor for spontaneous healing for up to 6 months 7
- If perforation persists beyond 6 months, surgical intervention (tympanoplasty) is warranted 7
- Biannual follow-up for a minimum of two years is recommended due to risk of cholesteatoma formation 7
Special Considerations
- Traumatic perforations from blunt trauma have better prognosis for spontaneous healing compared to blast trauma, thermal or caustic injuries 7
- Children demonstrate complete spontaneous recovery in most cases 4
- Seek immediate ENT consultation if the patient experiences:
Common Pitfalls to Avoid
- Never irrigate the ear canal when tympanic membrane perforation is present or suspected 8, 1
- Avoid using cotton-tipped applicators in the ear canal as they may cause further trauma 1
- Do not use potentially ototoxic ear drops that could damage middle ear structures 2, 1
- Avoid procedures that create pressure in the ear canal, such as pneumatic otoscopy 3