From the Guidelines
A perforated eardrum should be treated with caution, keeping the ear dry and avoiding further trauma, and in cases of infection, topical quinolone antibiotics such as ofloxacin (Floxin Otic) or ciprofloxacin with dexamethasone (Ciprodex) may be prescribed, typically 3-4 drops twice daily for 7-10 days, as evidenced by 1. When managing a perforated eardrum, it is crucial to prioritize measures that prevent infection and promote healing. This includes keeping the ear dry by using earplugs or cotton balls coated with petroleum jelly while showering and avoiding swimming until healing is complete. For pain management, over-the-counter medications like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can be used as directed. Some key considerations in the treatment of a perforated eardrum include:
- Avoiding the use of irrigation, especially in the presence of a perforated tympanic membrane, as it may lead to infection, pain, or ototoxic hearing loss, or produce caloric effects resulting in vertigo, as noted in 1.
- Mechanical removal of cerumen is the preferred technique when the eardrum is not intact, highlighting the importance of careful management to prevent further damage.
- For larger perforations or those that don't heal naturally, medical intervention such as patching procedures or tympanoplasty surgery may be necessary, with the choice of graft material potentially influencing outcomes, as suggested by 1. It is essential to seek immediate medical attention if symptoms such as severe pain, hearing loss, dizziness, or drainage from the ear occur, as these may indicate complications requiring prompt treatment.
From the Research
Treatment for Perforated Ear Drum
- The treatment for a perforated ear drum, also known as a ruptured eardrum, typically involves managing the underlying cause of the perforation, such as an ear infection, and promoting healing of the eardrum.
- According to a study published in 2006 2, topical quinolone antibiotics can clear aural discharge better than systemic antibiotics in cases of chronically discharging ears with an underlying eardrum perforation.
- The study found that topical quinolone antibiotics were more effective than systemic antibiotics at clearing discharge at 1-2 weeks, with relative risks of 3.21 and 3.18, respectively.
- However, the study also noted that the evidence regarding safety was weak, and further studies were needed to clarify the effectiveness and safety of topical non-quinolones and antiseptics.
Pain Management
- For pain management in cases of acute otitis media (AOM), which can cause a perforated ear drum, paracetamol (acetaminophen) or non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used 3.
- A study published in 2016 found that both paracetamol and ibuprofen were more effective than placebo in relieving pain at 48 hours, with low quality evidence suggesting that adverse events did not significantly differ between children treated with either paracetamol, ibuprofen, or placebo.
- Another study published in 2023 4 found that antibiotics may have a modest effect on pain relief in children with AOM, but the benefits must be weighed against the possible harms, such as adverse events like vomiting, diarrhea, or rash.
Antibiotic Treatment
- The use of antibiotics in cases of perforated ear drum is generally reserved for cases where there is a high risk of complications, such as in children with underlying medical conditions or in cases where the perforation is large or persistent 4.
- A study published in 2023 found that immediate antibiotics may result in a reduction of pain at two to three days, but probably do not reduce the risk of pain at three to seven days, and may not reduce the risk of pain at 11 to 14 days.
- The study also found that immediate antibiotics increase the risk of adverse events, such as vomiting, diarrhea, or rash, and that the benefits of antibiotics must be weighed against the possible harms.