What is the management of a ruptured tympanic membrane (eardrum)?

From the Guidelines

Management of a ruptured tympanic membrane should prioritize the use of non-ototoxic topical preparations, as recommended by the clinical practice guideline for acute otitis externa 1. When managing a ruptured tympanic membrane, it is essential to consider the potential for infection and the importance of promoting healing.

• Protecting the ear from water and infection is crucial, and this can be achieved by keeping the ear dry and avoiding the insertion of objects into the ear canal.
• The use of non-ototoxic topical preparations, as recommended by the guideline 1, is based on a preponderance of benefit over harm, despite the aggregate evidence quality being Grade C.
• Pain management can be achieved with acetaminophen or ibuprofen, and antibiotic ear drops may be prescribed if there is evidence of infection.
• It is also important to note that most tympanic membrane perforations heal spontaneously within 1-3 months without intervention, and surgical repair may be considered for perforations that don't heal spontaneously or for large perforations.
• Patients should follow up with a healthcare provider if symptoms worsen, drainage persists beyond 2 weeks, hearing does not improve, or the perforation fails to heal within 3 months. The guideline's recommendation for non-ototoxic topical preparations is based on reasoning from first principles and exceptional circumstances where validating studies cannot be performed 1, and it is essential to prioritize this approach in the management of a ruptured tympanic membrane.

From the Research

Rupture Tympanic Membrane Management

• The management of rupture tympanic membrane involves various approaches, including expectant management, use of materials to aid in recovery, and medical treatment 2.
• Expectant management is the most common approach, where the patient is advised to wait for spontaneous healing, which usually occurs in a few weeks 2.
• The use of bacterial cellulose film has been shown to promote immediate functional and symptomatic recovery in patients with traumatic perforations of the tympanic membrane 2.
• Antibiotics may be prescribed in some cases, but their use is not always necessary and should be weighed against the possible harms, such as adverse events like vomiting, diarrhea, or rash 3, 4.
• In cases of acute otitis media with spontaneous tympanic membrane perforation, the principal aim is to present the current knowledge regarding this condition and to address the question of whether it is a disease with specific characteristics or a severe case of acute otitis media 5.
• Topical corticosteroids, such as dexamethasone, have been shown to hinder tympanic membrane healing in a chinchilla model of acute otitis media, and their use is not recommended 6.

Treatment Options

• Bacterial cellulose film: promotes immediate functional and symptomatic recovery in patients with traumatic perforations of the tympanic membrane 2.
• Antibiotics: may be prescribed in some cases, but their use is not always necessary and should be weighed against the possible harms 3, 4.
• Topical corticosteroids: hinder tympanic membrane healing in a chinchilla model of acute otitis media, and their use is not recommended 6.

Considerations

• Expectant management is the most common approach, where the patient is advised to wait for spontaneous healing, which usually occurs in a few weeks 2.
• The use of materials to aid in recovery, such as bacterial cellulose film, may promote immediate functional and symptomatic recovery 2.
• Antibiotics should be prescribed judiciously, taking into account the possible harms and benefits 3, 4.
• Further studies are needed to determine whether acute otitis media with spontaneous tympanic membrane perforation is a distinct disease with specific aetiological, clinical, and prognostic characteristics or a more severe case of acute otitis media 5.