Is it safe to prescribe ear drops to someone with a scab (wound) on their eardrum?

Ear Drops with Tympanic Membrane Perforation (Scab on Eardrum)

Yes, you can prescribe ear drops to someone with a scab or perforation on the eardrum, but you MUST use non-ototoxic topical preparations specifically approved for middle ear use—avoid aminoglycoside-containing drops and choose fluoroquinolone-based preparations instead. 1

Key Decision Point: Tympanic Membrane Status

When a perforation, scab, or any break in the tympanic membrane is present (or suspected), the critical factor is selecting the appropriate ear drop formulation 1:

Non-Ototoxic Options (SAFE for perforated eardrums):

• Fluoroquinolone-based drops are the preferred choice for non-intact tympanic membranes 1
• These include ciprofloxacin-based preparations (Ciprodex, Ciloxan) and ofloxacin (Floxin) 2, 3
• These medications provide excellent antimicrobial coverage without ototoxic effects when they contact the middle ear 4

Ototoxic Options to AVOID (with perforated eardrums):

• Aminoglycoside-containing drops (neomycin, gentamicin) should NOT be used with non-intact tympanic membranes 5, 6
• Cortisporin (polymyxin B-neomycin-hydrocortisone) is particularly problematic—it causes both ototoxicity and inflammatory responses in the middle ear 4, 7
• If aminoglycosides must be used in exceptional circumstances, limit treatment to maximum 2 weeks with baseline audiometry 6

Clinical Algorithm for Prescribing

Step 1: Assess tympanic membrane integrity

• Direct visualization of perforation, scab, or wound 1
• History of tympanostomy tubes (even if not visible) 1
• Patient reports tasting ear drops (indicates middle ear communication) 1, 3

Step 2: Select appropriate formulation

• Non-intact membrane → fluoroquinolone drops only 1, 2
• Intact membrane with external otitis → broader options available including aminoglycosides 5

Step 3: Prescribe treatment duration

• Minimum 7 days of therapy, even if symptoms improve earlier 1, 3
• Maximum 7 additional days if symptoms persist beyond initial week 1
• Expect improvement within 48-72 hours 2, 3

Administration Instructions for Patients

For optimal drug delivery with tympanic membrane perforation 2, 3:

• Lie with affected ear upward
• Instill prescribed number of drops
• Pump the tragus 4 times to facilitate penetration through perforation 2
• Maintain position for 5 minutes 2
• Gently clean drainage with cotton-tipped swab dipped in hydrogen peroxide before administering drops 2

Critical Precautions

Water exposure: 2, 3

• Keep ear dry during treatment
• Cover ear canal with petroleum jelly-coated cotton or earplug when showering
• Avoid swimming until drainage stops

Activity restrictions: 3

• No scratching or touching the ear
• Do not insert cotton-tipped swabs deep into canal
• Avoid cleaning the ear yourself during acute infection

Common Pitfalls to Avoid

1. Using aminoglycoside drops with known perforation—this is the most serious error, as sensorineural hearing loss can result 6, 4

2. Failing to use tragus pumping technique—essential for medication penetration through perforation into middle ear 2

3. Stopping treatment when symptoms improve—complete the full 7-day course to prevent relapse 1, 3

4. Not educating patients about the "tasting drops" phenomenon—this is expected with perforations and indicates proper middle ear penetration 1, 3

5. Prescribing oral antibiotics instead of topical therapy—topical drops are more effective for ear infections and avoid systemic antibiotic resistance 1

When to Reassess

Contact or return if 1, 2:

• No improvement within 48-72 hours
• Drainage persists beyond 7 days despite appropriate therapy
• Pain worsens or new symptoms develop
• Local rash, severe irritation, or unexpected symptoms occur