From the Guidelines
Treatment for a ruptured tympanic membrane typically involves allowing the ear to heal on its own while preventing infection, with the use of non-ototoxic topical preparations, such as antibiotic ear drops, being recommended for patients with a known or suspected perforation of the tympanic membrane 1. The goal is to keep the ear dry and prevent infection, allowing the eardrum to heal within 1-3 months without surgical intervention. Some key points to consider in the treatment of a ruptured tympanic membrane include:
- Keeping the ear dry by placing a cotton ball coated with petroleum jelly in the outer ear during showers and avoiding swimming until healing is complete
- Using antibiotic ear drops, such as ofloxacin (Floxin Otic) or ciprofloxacin with dexamethasone (Ciprodex), typically 3-4 drops twice daily for 7-10 days, if there's drainage
- Avoiding the use of oral antibiotics unless there's evidence of a more extensive infection
- Managing pain with over-the-counter medications like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin)
- Avoiding inserting anything into the ear canal, including cotton swabs
- Considering surgical repair, called tympanoplasty, if the rupture is large or doesn't heal within 3 months 1. It's worth noting that the use of quinolone-containing eardrops has been shown to be effective in clearing aural discharge in the short term, and that treating patients with a combination of systemic and topical antibiotics is not more effective than topical antibiotics alone 1. Overall, the treatment of a ruptured tympanic membrane should prioritize preventing infection and promoting healing, while also managing symptoms and preventing complications. The use of non-ototoxic topical preparations, such as antibiotic ear drops, is a key component of this treatment approach 1.
From the Research
Ruptured Tympanic Membrane Treatment
- The treatment for a ruptured tympanic membrane can vary depending on the size and location of the perforation, as well as the overall health of the patient 2.
- Conservative follow-up until spontaneous complete recovery is often the most common choice for treating traumatic perforation of the tympanic membrane (TPTM) 2.
- A study of 80 patients with TPTM found that 56 patients recovered spontaneously, 3 patients underwent successful tympanoplasty, and 1 patient was referred to surgery but was lost to follow-up 2.
- Another study compared the efficacy of endoscopic transtympanic myringoplasty (ETM) and endoscopic type I tympanoplasty (ETT) for repairing medium- to large-sized tympanic membrane perforation, and found that the surgical outcome of ETM is comparable to that of ETT, but ETM is less invasive and has a shorter operative time than ETT 3.
Treatment Options
- Spontaneous recovery: All children in a study of 80 patients with TPTM demonstrated complete spontaneous recovery 2.
- Tympanoplasty: 3 patients in the same study underwent successful tympanoplasty 2.
- Endoscopic transtympanic myringoplasty (ETM): A study found that ETM is a suitable option for simple perforation repair, regardless of the perforation size, and has a shorter operative time than ETT 3.
- Endoscopic type I tympanoplasty (ETT): A study found that ETT is an effective, minimally traumatic procedure for repairing tympanic membrane perforation, but requires tympanomeatal flap elevation which can lead to chorda tympani nerve injury, bleeding, and wound healing drawbacks 3.
Considerations
- The benefits and risks of antibiotics for acute otitis media (AOM) should be weighed, as antibiotics may have no effect on pain at 24 hours, a slight effect on pain in the days following, and only a modest effect on the number of children with tympanic perforations, contralateral otitis episodes, and abnormal tympanometry findings at two to four weeks compared with placebo in children with AOM 4.
- The use of antibiotics may increase the risk of adverse events such as vomiting, diarrhea, or rash 4.
- Clinical management should emphasize advice about adequate analgesia and the limited role for antibiotics 4.