Is it normal to taste ciprofloxacin-dexamethasone (a topical fluoroquinolone eardrop) after instillation, given that I have a known perforated tympanic membrane?

Tasting Eardrops with Tympanic Membrane Perforation

Yes, tasting ciprofloxacin-dexamethasone eardrops after instillation is expected and confirms the presence of your known tympanic membrane perforation, as the medication is passing through the perforation into your middle ear and down the eustachian tube to your throat. 1

Why This Occurs

• When eardrops are instilled in an ear with a perforated tympanic membrane, the medication can pass through the perforation into the middle ear space, travel down the eustachian tube, and reach the nasopharynx and oropharynx, where you taste them 1
• The American Academy of Otolaryngology-Head and Neck Surgery explicitly states: "If you taste the eardrops it means there is likely a hole or perforation of the eardrum" 1
• This taste sensation confirms that the medication is reaching the middle ear space, which is actually the intended target when treating middle ear infections with a perforation 1

Safety of Ciprofloxacin-Dexamethasone with Perforation

• Quinolone antibiotics like ciprofloxacin are explicitly recommended as safe and non-ototoxic for use with tympanic membrane perforations 2
• The American Academy of Otolaryngology-Head and Neck Surgery recommends quinolone-containing ear drops (ofloxacin, ciprofloxacin) when a tympanic membrane perforation is known or suspected 2
• Aminoglycoside-containing drops (like neomycin) should be avoided due to ototoxicity risk, but quinolones do not carry this risk 2

Important Caveat About the Dexamethasone Component

• While ciprofloxacin is safe for perforations, the dexamethasone (steroid) component may delay healing of the perforation itself 2, 3, 4
• Research shows that ciprofloxacin combined with dexamethasone delays tympanic membrane healing more than ciprofloxacin alone, with healing delayed up to 35 days in animal studies 4
• However, this delayed healing is generally temporary—all perforations eventually healed in research studies, though it took longer with the steroid-containing preparation 3, 4
• The steroid component provides better symptom relief (reduced inflammation and pain), which is why the combination is often prescribed despite the healing delay 5

What You Should Do

• Inform your doctor that you are tasting the drops (if you haven't already), as this confirms the perforation and may influence treatment decisions 1
• Continue using the drops as prescribed—the taste is expected and does not indicate a problem with safety 1
• Ensure the ear canal is clean before administering drops so medication can reach the middle ear effectively 2
• Use "pumping" motions on the tragus (the small flap of cartilage in front of your ear canal) after instilling drops to help them penetrate into the middle ear 2
• Implement water precautions during treatment—keep water out of the ear until the infection and discharge resolve 1, 2

Expected Timeline and Follow-Up

• Most patients feel better within 48-72 hours and have minimal symptoms by 7 days 1, 5
• Treatment should continue for at least 7 days even if symptoms improve sooner, to prevent relapse 1, 5
• If symptoms persist beyond 7 days, notify your doctor and continue drops for up to an additional 7 days maximum 1, 5
• Follow-up within 1-2 weeks is recommended to assess healing and resolution of infection 2

When to Contact Your Doctor

• If the drops become painful or you develop unexpected symptoms 1
• If symptoms fail to improve within 48-72 hours 1
• If you develop signs of severe infection, cellulitis around the ear, or worsening symptoms despite treatment 2, 5