Contact Sports Participation with Healing TM Perforation from AOM
A preteen with a resolving ruptured eardrum from acute otitis media who feels well does not need to abstain from contact sports during the healing period. 1
Key Recommendation
There is no evidence-based restriction on contact sports for children with healing tympanic membrane perforations from acute otitis media. The primary concern with TM perforations is keeping the ear dry to prevent infection, not avoiding physical contact or impact. 2, 3
Clinical Reasoning
Water Precautions vs. Contact Sports
The American Academy of Otolaryngology-Head and Neck Surgery explicitly recommends against routine prophylactic water precautions (earplugs, headbands, avoidance of swimming) for children with tympanostomy tubes, which create intentional TM perforations. 1
If water exposure during swimming is not contraindicated for intentional TM perforations, there is no physiologic basis to restrict contact sports for healing spontaneous perforations from AOM. 1
The main management principle is keeping the ear dry to prevent infection, not avoiding physical activity or contact. 2, 3
Natural History of AOM-Related Perforations
Most small perforations from acute otitis media resolve spontaneously within weeks, with healing rates exceeding 90% in children. 4, 5
Traumatic perforations (from blunt or penetrating trauma) have different healing characteristics than infectious perforations, but even traumatic perforations in children demonstrate complete spontaneous recovery in most cases. 4
The perforation itself is not mechanically fragile once the acute infection is resolving—the concern is introducing water or infection, not physical impact. 6
Practical Management
What Actually Matters
Keep the ear dry during showering and bathing until healed. 2, 3
Avoid swimming until the perforation has healed (this is the only activity restriction needed). 3
Do not use cotton-tipped applicators in the ear canal. 3
Ensure adequate pain control if needed (acetaminophen or NSAIDs for mild-moderate pain). 2, 3
Follow-Up Timing
Reassess at 48-72 hours if symptoms worsen or new drainage develops. 3
Most AOM-related perforations heal within 1 month; otolaryngology referral is indicated only if the perforation persists beyond this timeframe. 6
Common Pitfall to Avoid
Do not conflate water exposure restrictions with contact sports restrictions. The evidence clearly distinguishes between these: water can introduce infection through a perforation, but physical contact or impact does not pose the same risk. The guideline recommendation against routine water precautions for tympanostomy tubes (which are intentional perforations) further supports that physical activity restrictions are unnecessary. 1