What is the treatment for a perforated tympanic membrane (eardrum)?

From the Guidelines

Treatment for an open hole in the eardrum, known as a tympanic membrane perforation, typically involves using eardrops that are approved for use in the middle ear, as some of the medication may get past the eardrum 1.

Key Considerations

• The choice of eardrop should be discussed with a doctor, considering factors such as cost, dosing frequency, and the doctor's experience 1.
• It is essential to inform the doctor if there is an opening or perforation of the eardrum, as this may affect the choice of eardrop 1.
• Eardrops are generally safe and well-tolerated, but some people may experience local rash, itching, irritation, or discomfort 1.

Management

• For small perforations, watchful waiting may be recommended, with the ear kept dry using earplugs or cotton balls coated with petroleum jelly while showering, and avoiding swimming.
• If the perforation is due to infection, antibiotic ear drops such as ofloxacin may be prescribed, with a typical dosage of 5 drops, 2 times daily for 7-10 days.
• Pain management can include acetaminophen or ibuprofen as needed, and it is crucial to avoid inserting anything into the ear canal.
• If symptoms persist or worsen, it is essential to see a doctor immediately, as this may indicate complications such as infection spreading to the middle ear or inner ear structures.

Activity Restrictions

• Avoid scratching or touching the ear, and do not insert anything into the ear canal, including cotton-tipped swabs.
• Cover the opening of the ear canal with an earplug or cotton (with petroleum jelly) prior to showering or hair washing to minimize water entry.
• Check with a doctor regarding swimming or other water activities that may take place during, or soon after, the infection.

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. Chronic Suppurative Otitis Media with perforated tympanic membranes

The treatment for an open hole in the eardrum (perforated tympanic membrane) is ofloxacin (OTIC). The recommended dosage is:

• Ten drops (0.5 mL, 1.5 mg ofloxacin) instilled into the affected ear twice daily for fourteen days 2.
• The solution should be warmed by holding the bottle in the hand for one or two minutes to avoid dizziness that may result from the instillation of a cold solution.
• The patient should lie with the affected ear upward, before instilling the drops.
• The tragus should then be pumped 4 times by pushing inward to facilitate penetration into the middle ear.
• This position should be maintained for five minutes.

From the Research

Treatment Options for Open Hole in the Eardrum

• There are several treatment options available for an open hole in the eardrum, including the use of antibiotics, Gelfoam plugs, and surgical procedures such as tympanoplasty 3, 4, 5.
• A study published in 2007 found that exposure to ciprofloxacin/dexamethasone delayed the healing of tympanic membrane perforations in rats, but the brief exposure in the study did not cause persistent perforations 3.
• Another study published in 2011 found that the use of a Gelfoam plug in combination with surgical removal of the perforation edges resulted in a closure rate of 83% in patients with small eardrum perforations 4.

Surgical Procedures

• Endoscopic tympanoplasty type I is a reliable technique with reasonable anatomic and audiologic results, and tympanic membrane grafting with cartilage (or cartilage and perichondrium) guarantees a higher rate of perforation closure and satisfactory hearing results 5.
• A randomized, double-blind controlled trial published in 2021 found that the application of ciprofloxacin impregnated gelfoam in the middle ear and external auditory canal had no adverse effect on the graft success rate in tympanoplasty 6.

Use of Antibiotics

• A systematic review published in 2023 found that antibiotics do not reduce pain at 24 hours, but result in almost a third fewer children having pain at two to three days, and likely result in two-thirds fewer having pain at 10 to 12 days in children with acute otitis media 7.
• The review also found that 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 7.