What is the treatment for ear drum perforation?

Treatment for Ear Drum Perforation

The treatment for ear drum perforation depends on the cause and size of the perforation, with most traumatic perforations healing spontaneously while chronic perforations may require surgical intervention. 1

Types and Causes of Ear Drum Perforations

• Ear drum perforations can be categorized as either acute or chronic 2
• Common causes include trauma, acute middle ear infections, or chronic middle ear infections 1
• Perforations result in conductive hearing loss and predispose the middle ear to infections 1

Management of Acute Perforations

Traumatic Perforations

• Most traumatic perforations heal spontaneously without specific intervention 1, 2
• Keep the ear dry to prevent infection while healing occurs 1
• Avoid irrigation or use of cerumen-removing/softening drops in ears with perforated eardrums 3

Infection-Related Acute Perforations

• Perforations caused by acute middle ear infections should be treated with appropriate antibiotics 1
• When treating ear infections in patients with perforated eardrums, non-ototoxic preparations like ofloxacin should be used rather than potentially ototoxic alternatives 4
• If the tympanic membrane cannot be fully visualized due to swelling or discharge, it's safest to use non-ototoxic preparations 4

Management of Chronic Perforations

• Chronic perforations due to chronic middle ear infection or cholesteatoma typically will not heal without surgical intervention 1, 2
• Surgical options include:
  • Myringoplasty using various techniques such as:
    • Gelfoam® plug technique (83% success rate) for small perforations 5
    • Butterfly cartilage tympanoplasty for larger perforations (94% success rate) 6

Special Considerations

• Patients with perforated eardrums should avoid:
  • Getting water in the ear 1
  • Ear irrigation, which could cause infection or vertigo 3
  • Using cerumen-removing drops unless specifically cleared by an otolaryngologist 3
• Patients should seek medical attention if they experience:
  • Continuous pain
  • Vertigo
  • Facial paralysis
  • Persistent perforation 1

Referral to ENT Specialist

• Most uncomplicated perforations can be managed in primary care 1
• ENT consultation is necessary when:
  • Alarming signs are present (continuous pain, vertigo, facial paralysis)
  • The perforation persists beyond expected healing time
  • The perforation is associated with cholesteatoma, which requires surgical management 1, 2

Prevention of Complications

• Keep the ear dry to prevent middle ear infections 1
• Avoid inserting objects into the ear canal that could cause trauma to the eardrum 3
• Patients with diabetes require special caution with ear irrigation due to higher risk of malignant otitis externa 3