From the Guidelines
It is not recommended to lavage a cerumenous ear with a small TM rupture due to the risk of pushing water, debris, and bacteria into the middle ear, potentially causing infection or further damage. According to the clinical practice guideline update on earwax (cerumen impaction) published in 2017 1, patients with a history of ear surgery or a perforated eardrum should avoid irrigation or using cerumen-removing/softening drops unless specifically cleared to do so by an otolaryngologist. Key considerations for managing cerumen impaction in the presence of a TM rupture include:
- Avoiding irrigation to prevent introducing infection into the middle ear
- Potential use of antibiotic ear drops if signs of infection are present, such as those containing fluoroquinolones like ciprofloxacin or ofloxacin
- Manual removal of cerumen under direct visualization by an experienced clinician using microsuction or gentle debridement with specialized instruments
- Evaluation and management of the underlying TM perforation, which may involve keeping the ear dry, avoiding swimming, and using earplugs during showering with a cotton ball coated with petroleum jelly to facilitate healing. As noted in the guideline, cerumen impaction can impair the ability to visualize the tympanic membrane and assess the status of the middle ear, highlighting the importance of careful management in cases with known or suspected TM rupture 1.
From the Research
Lavage of Cerumenous Ear with Small TM Rupture
- The provided studies do not directly address the question of lavaging a cerumenous ear with a small tympanic membrane (TM) rupture.
- However, studies 2, 3 discuss the effects of certain medications on TM healing, which may be relevant to the consideration of lavage in the presence of a TM rupture.
- Study 4 examines the effectiveness of ofloxacin ear drops in traumatic TM healing, but does not specifically address lavage or cerumenous ears.
- Study 5 evaluates how closure of TM perforations affects hearing and middle ear mechanics, which may be relevant to the consideration of lavage in the presence of a TM rupture.
- Study 6 discusses the treatment of chronic suppurative otitis media with topical ciprofloxacin, but does not directly address the question of lavaging a cerumenous ear with a small TM rupture.
Considerations for Lavage
- When considering lavage of a cerumenous ear with a small TM rupture, it is essential to weigh the potential benefits against the potential risks, including further damage to the TM or introduction of infection.
- The use of certain medications, such as ciprofloxacin/dexamethasone, may delay TM healing, as noted in studies 2, 3.
- The effectiveness of ofloxacin ear drops in promoting TM healing, as discussed in study 4, may be relevant to the consideration of lavage in the presence of a TM rupture.
- The impact of TM perforation size on hearing loss and recovery, as examined in study 5, may also be a consideration in the decision to perform lavage.