From the Guidelines
Otitis media with a perforated tympanic membrane should be treated with a non-ototoxic topical preparation, as recommended by the clinical practice guideline for acute otitis externa 1. When managing otitis media with a perforated tympanic membrane, it is essential to consider the potential risks and benefits of different treatment options.
- The use of topical antibiotic ear drops is preferred over oral antibiotics due to their ability to deliver higher concentrations of medication directly to the infection site while minimizing systemic side effects.
- The recommended treatment should be based on the most recent and highest quality evidence available, which in this case is the clinical practice guideline for acute otitis externa 1.
- According to this guideline, a non-ototoxic topical preparation should be prescribed when the patient has a known or suspected perforation of the tympanic membrane.
- Although the guideline does not specify a particular medication, ciprofloxacin 0.3% with dexamethasone 0.1% otic drops or ofloxacin 0.3% otic drops are commonly used treatments for otitis media with a perforated tympanic membrane.
- It is crucial to keep the ear dry during treatment and avoid inserting anything into the ear canal to promote healing and prevent further complications.
- Pain management with acetaminophen or ibuprofen as needed is also an essential aspect of treatment.
- Follow-up care is necessary if drainage persists beyond 7-10 days of treatment or if symptoms worsen, and persistent perforations may require surgical repair.
From the FDA Drug Label
Chronic Suppurative Otitis Media with perforated tympanic membranes 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.
The recommended treatment for otitis media with perforated tympanic membrane using ofloxacin (OTIC) is:
- Ten drops (0.5 mL, 1.5 mg ofloxacin) instilled into the affected ear twice daily for fourteen days in patients 12 years and older 2.
- For patients under 12 years old, the label does not provide a recommended dosage regimen for this specific condition.
From the Research
Otitis Media with Perforated Tympanic Membrane
- Otitis media with perforated tympanic membrane is a condition where the eardrum is perforated, often due to an infection [ 3 ].
- The distribution of bacteria causing otitis media has changed over time, with non-typeable Haemophilus influenzae and Streptococcus pneumoniae being common pathogens [ 3 ].
- A study found that non-typeable H. influenzae was the most common pathogen in children with acute otitis media and spontaneous tympanic membrane perforation, followed by Moraxella catarrhalis and S. pneumoniae [ 4 ].
Causes and Risk Factors
- Recurrent acute otitis media episodes appear to be associated with an increased risk of otitis media with spontaneous tympanic membrane perforation [ 4 ].
- Non-typeable H. influenzae is detected at a high frequency in children with recurrent spontaneous tympanic membrane perforation and often in association with other pathogens [ 4 ].
- Early Streptococcus pneumoniae infection and coinfections with non-typeable Haemophilus influenzae may be precursors to spontaneous tympanic membrane perforation [ 5 ].
Treatment and Management
- Antibiotic prophylaxis has fallen into disfavor as a preventative strategy for acute otitis media recurrences [ 3 ].
- Amoxicillin/clavulanate in high dosage may be the preferred treatment for otitis media based on the current otopathogen mix [ 3 ].
- A case study found that treatment with topical triamcinolone through the perforated tympanic membrane improved symptoms and hearing levels in a patient with eosinophilic otitis media [ 6 ].