Treatment of Tympanic Membrane Rupture
Most tympanic membrane perforations heal spontaneously with conservative management—keep the ear dry and use only non-ototoxic topical antibiotics if infection develops. 1, 2
Initial Conservative Management
The primary treatment approach is watchful waiting with ear precautions:
- Keep the ear completely dry to prevent secondary infection 1, 2
- Avoid water exposure during bathing and swimming 1
- Never irrigate the ear or perform pneumatic otoscopy as these can worsen injury or introduce infection 1
- Use only non-ototoxic topical preparations if treating associated infections, as ototoxic agents can cause severe hearing loss 1
Spontaneous healing rates are excellent for most etiologies:
- Traumatic perforations from blunt or penetrating injury heal spontaneously in the vast majority of cases 2, 3, 4
- All children in one series (n=20) demonstrated complete spontaneous recovery 3
- Mean healing time is approximately 6-8 weeks for uncomplicated traumatic perforations 3
When to Escalate Beyond Conservative Management
Perforations lasting 6 months or longer warrant surgical intervention 4
Immediate ENT referral is required for:
- Continuous pain, vertigo, or facial paralysis 2
- Suspected perilymphatic fistula with persistent vestibular symptoms or sensorineural hearing loss 4
- Immediate complete facial nerve paralysis 4
- Blast injuries, thermal injuries, or caustic injuries (less likely to heal spontaneously) 4
Surgical Options for Persistent Perforations
Tympanoplasty is the preferred surgical procedure for chronic perforations:
- Cartilage reconstruction provides superior structural outcomes compared to temporalis muscle fascia, with better graft integration rates (92.4% vs 84.3%) and fewer postoperative perforations 5, 6
- Hearing outcomes are similar between cartilage and fascia grafts 5
Novel adjuvant therapies show promising results:
- Basic fibroblast growth factor (b-FGF) with gelatin sponge scaffold achieves 98.1% closure rate versus 10% with saline control 5, 1, 7
- Epidermal growth factor (EGF) application after freshening perforation edges demonstrates similar high closure rates 7
- Various bioengineered scaffolds are safe and improve healing rates 5, 1
Special Considerations
For perforations with active infection:
- Use topical antibiotics for acute otitis media-related perforations 2
- Atraumatic cleaning with aural suctioning under microscopic guidance for diabetic or immunocompromised patients 1
- Topical antifungals for otomycosis, with oral agents for refractory cases 1
Long-term monitoring is essential: