From the Guidelines
Management of tympanic membrane perforation should prioritize a stepwise approach, starting with watchful waiting for small perforations, and considering topical antibiotic drops like quinolones for infected cases, given their non-ototoxic properties and effectiveness in clearing aural discharge, as shown in a study published in Nature Reviews Disease Primers 1. When managing tympanic membrane perforation, it's essential to consider the cause, size, and symptoms of the perforation. For small perforations, watchful waiting is often recommended, as many heal spontaneously within 3 months. During this period, patients should keep the ear dry by using earplugs or cotton balls coated with petroleum jelly when showering, and avoid swimming. For infected perforations, topical antibiotic drops are prescribed, with quinolones being a suitable option due to their non-ototoxic properties and effectiveness in clearing aural discharge, as demonstrated in a study on otitis media 1. The use of quinolone-containing eardrops has been shown to be more effective than no drug treatment, topical antiseptics, and systemic antibiotics in clearing CSOM-related aural discharge in the short term. Key considerations in the management of tympanic membrane perforation include:
- Avoiding the use of drops containing alcohol or potentially ototoxic agents
- Considering surgical repair (tympanoplasty) for perforations that don't heal spontaneously, especially for larger defects or those causing significant hearing loss
- Advising patients to avoid forceful nose blowing, which can force bacteria into the middle ear through the Eustachian tube
- Regular follow-up to monitor healing progress and address any complications promptly, such as conductive hearing loss, recurrent infections, and cholesteatoma formation.
From the Research
Management of Tympanic Membrane Perforation
- The management of tympanic membrane perforation can be conservative or surgical, depending on the severity and cause of the perforation 2.
- Conservative management may involve the use of ear drops, such as ofloxacin, to promote healing and prevent infection 3, 4.
- Studies have shown that ofloxacin ear drops can increase the rate of tympanic membrane closure and reduce healing time 3.
- However, the use of ciprofloxacin/dexamethasone ear drops may delay healing of tympanic membrane perforations 4, 5.
- In some cases, tympanic membrane perforation may occur during intrapartum valsalva maneuver, and conservative management may be sufficient for resolution 6.
- The decision to refer a patient to an otolaryngologist depends on the severity of the perforation and the presence of other complications 2.
- Surgical repair may be necessary in some cases, such as when the perforation is large or persistent 2.
- The use of postoperative ear drops, such as ciprofloxacin-dexamethasone, may not have a significant effect on the success of tympanoplasty 5.