Treatment for Posterior Perforation of the Ear Drum
The primary treatment for a posterior perforation of the ear drum involves keeping the ear dry, avoiding irrigation, using only non-ototoxic preparations if infection is present, and allowing for spontaneous healing in most cases, with surgical intervention reserved for perforations that fail to heal. 1, 2, 3
Initial Management
- Keep the ear dry to prevent infections that may impede the healing process 1, 2
- Avoid ear irrigation and pneumatic otoscopy which could cause further damage or introduce infection 1, 3
- Clean the ear canal carefully to remove any debris, blood, or purulent secretions to create optimal conditions for healing 2, 4
- If infection is present, use only non-ototoxic antibiotic preparations such as ofloxacin rather than potentially ototoxic alternatives 1, 3
Healing Process
- Most small perforations, especially traumatic ones, heal spontaneously within 1-2 months without intervention 5, 6
- Monitor the perforation for at least 6-8 weeks to assess healing progress 6, 7
- All pediatric cases in studies showed complete spontaneous recovery without intervention 6
- Spontaneous healing rates of up to 95% have been reported with watchful waiting approach 7
Advanced Treatment Options for Non-Healing Perforations
- For perforations that don't heal spontaneously after 4-6 weeks, consider the following options:
- Application of growth factors such as basic fibroblast growth factor (b-FGF) with a gelatin sponge scaffold, which has shown closure rates of up to 98.1% 2, 3
- Epidermal growth factor (EGF) application after freshening the perforation edges 2
- Simple patching with micropore tape has shown success rates of 99.1% in some studies 8
- Surgical closure through miringoplasty or tympanoplasty for persistent perforations 2, 5
Special Considerations
- Perforations caused by blast injuries require more aggressive management due to risk of secondary cholesteatoma formation 7
- Otolaryngology referral is necessary when:
Precautions During Healing
- Patients should avoid getting water in the ear during the healing process 1, 5
- Do not use cerumen-removing drops unless specifically cleared by an otolaryngologist 1
- Special caution is needed for patients with diabetes due to higher risk of malignant otitis externa 1
- Reevaluate if symptoms don't resolve completely after 2 weeks of treatment 2
The location of the perforation in the posterior portion of the tympanic membrane doesn't significantly alter the management approach, though posterior perforations may have slightly different healing characteristics than anterior ones 6, 7.