What is the treatment for a ruptured ear drum (tympanic membrane perforation)?

Treatment for Ruptured Ear Drum

For a ruptured ear drum (tympanic membrane perforation), the primary treatment is keeping the ear dry and allowing for spontaneous healing, which occurs in most cases without surgical intervention. 1, 2

Initial Assessment and Management

• Confirm diagnosis through careful otoscopic examination, noting the size and location of the perforation 1
• Avoid irrigation and pneumatic otoscopy as these can lead to middle ear infection or further damage 1, 3
• Carefully suction blood, purulent secretions, and debris from the ear canal to maintain cleanliness 3
• Assess for alarming signs that require immediate ENT referral: continuous pain, vertigo, facial paralysis, or significant hearing loss 2, 3

Conservative Management

• Most small perforations heal spontaneously within 1-2 months (48-56% spontaneous healing rate) 2, 4, 5
• Keep the affected ear dry to prevent infection 1, 2
• Use ear plugs or cotton balls coated with petroleum jelly when showering 1
• Avoid swimming until the perforation has healed completely 1
• Avoid inserting cotton-tipped applicators into the ear canal as they may cause further trauma 1

Medication Considerations

• For perforations associated with acute otitis media, oral antibiotics may be prescribed 2, 3
• When topical preparations are needed, only use non-ototoxic preparations to avoid potential harm to middle ear structures 6, 1
• Ofloxacin otic drops are FDA-approved for chronic suppurative otitis media with perforated tympanic membranes 7
  • For patients 12 years and older: Ten drops instilled into the affected ear twice daily for fourteen days 7
  • Recent evidence suggests ofloxacin can increase healing rates and reduce healing time for traumatic perforations 8

Special Considerations

• For perforations with significant edema of the ear canal, a wick may be placed to facilitate drug delivery 6
• The wick should preferably be made of compressed cellulose (not cotton balls) and may be moistened with an aqueous solution before medication application 6
• Avoid alcohol-containing drops as they can cause damage when entering the middle ear through the perforation 1

When to Refer to an Otolaryngologist

• Perforations that persist beyond one month 2, 3
• Presence of vertigo, significant hearing loss, or facial paralysis 2, 3
• Perforations resulting from chronic otitis media or cholesteatoma, which typically require surgical intervention 2
• Large perforations that are unlikely to heal spontaneously 5

Surgical Management

• Tympanoplasty may be required for perforations that do not heal spontaneously after 1-3 months 4, 5
• Approximately 52% of blast-related perforations require surgical intervention 5

Prognosis

• Most traumatic perforations in children heal spontaneously with complete recovery 4
• Long-term hearing loss is uncommon but can impact quality of life and, in some cases, ability to continue military service or certain occupations 5
• Only about 5% of patients with blast-related perforations require hearing aids 5