From the Guidelines
Treatment for perforated tympanic membranes should begin with a conservative approach, prioritizing keeping the ear dry and using non-ototoxic topical preparations, as recommended by recent guidelines 1. The primary goal is to allow the perforation to heal spontaneously within 1-3 months, while managing any active infection or discharge with antibiotic ear drops such as ofloxacin or ciprofloxacin with dexamethasone 1. Some key considerations include:
- Keeping the ear dry by avoiding water entry using cotton balls coated with petroleum jelly during showering and avoiding swimming until healing occurs
- Prescribing antibiotic ear drops for active infection or discharge
- Considering oral antibiotics like amoxicillin-clavulanate for more severe infections
- Managing pain with acetaminophen or NSAIDs
- Avoiding forceful nose blowing to prevent introducing bacteria into the middle ear
- Following up with a physician in 2-4 weeks to monitor healing progress Surgical repair (tympanoplasty) may be considered for perforations that don't heal after 3 months, are large, or cause significant hearing loss, as noted in recent studies 1. It's essential to prioritize a conservative approach, as the tympanic membrane has excellent regenerative capacity, with epithelial migration naturally closing many defects without intervention, as supported by the most recent and highest quality study 1.
From the FDA Drug Label
The recommended dosage regimen for the treatment of chronic suppurative otitis media with perforated tympanic membranes in patients 12 years and older is: Ten drops (0.5 mL, 1. 5 mg ofloxacin) instilled into the affected ear twice daily for fourteen days.
For pediatric patients (from 6 months to 13 years old) with Acute Otitis Media in pediatric patients with tympanostomy tubes, the recommended dosage is not directly for perforated tympanic membranes, however for Chronic Suppurative Otitis Media with perforated tympanic membranes there is no dosage for patients under 12 years old.
The treatment for perforated tympanic membranes with ofloxacin (OTIC) is ten drops (0.5 mL, 1.5 mg ofloxacin) instilled into the affected ear twice daily for fourteen days for patients 12 years and older 2.
- For patients under 12 years old, the provided information does not directly support a treatment dosage for perforated tympanic membranes.
- Key considerations for administration include warming the solution and maintaining the affected ear upward for five minutes after instillation.
- The tragus should be pumped 4 times by pushing inward to facilitate penetration into the middle ear.
From the Research
Treatment Options for Perforated Tympanic Membranes
- Conservative care is often sufficient for managing perforated tympanic membranes, with most cases not requiring surgical repair 3
- Topical application of ofloxacin otic drops can promote healing and reduce closure time for medium and large perforations 4, 5
- Gelatin sponge patching is also an effective treatment strategy for large traumatic tympanic membrane perforations, with high closure rates and shorter closure times compared to spontaneous healing 5
- The use of ciprofloxacin-dexamethasone ear drops after endoscopic tympanoplasty does not appear to affect perforation closure rates 6
Surgical Interventions
- Tympanoplasty is a common surgical treatment for perforated tympanic membranes, with a success rate of around 67% 7
- Stapedectomy is often recommended in cases of tympanosclerosis, although mobilization techniques can also be used 7
- Teflon piston can be used in some cases, although its use is relatively rare 7
Additional Considerations
- Tympanosclerosis is a potential complication of chronic otitis media, characterized by the deposition of calcareous plaques in the tympanic membrane and middle ear mucosa 7
- Topical or systemic agents have shown promise in experimental studies for the treatment of tympanosclerosis, although further research is needed to confirm their effectiveness 7