Treatment of Ruptured Eardrum in Adults

Initial Assessment and Management

The American Academy of Otolaryngology-Head and Neck Surgery recommends confirming the diagnosis of a ruptured eardrum through careful otoscopic examination, noting the size and location of the perforation 1
Signs of infection, such as otorrhea, canal edema, and erythema, should be looked for in patients with a ruptured eardrum 1, 3
Perforation characteristics, including size and location, should be assessed in patients with a ruptured eardrum 1
Host factors, such as diabetes and immunocompromised state, should be considered in patients with a ruptured eardrum 1, 2

The American Academy of Otolaryngology-Head and Neck Surgery recommends keeping the ear dry to prevent infection in patients with a ruptured eardrum 1
Avoiding swimming until the perforation has healed is recommended for patients with a ruptured eardrum 1
Not using cotton-tipped applicators in the ear canal is recommended to prevent further trauma or leaving behind fibers in patients with a ruptured eardrum 1, 2
Mild to moderate pain can be managed with acetaminophen or NSAIDs in patients with a ruptured eardrum 2, 4
Moderate to severe pain can be managed with combination products containing oxycodone or hydrocodone in patients with a ruptured eardrum 2, 4

The American Academy of Otolaryngology-Head and Neck Surgery recommends using topical fluoroquinolone antibiotics as the treatment of choice for patients with a ruptured eardrum and signs of infection 1, 2
Ciprofloxacin-dexamethasone combination provides superior efficacy with added anti-inflammatory benefit in patients with a ruptured eardrum and signs of infection 1, 2
Topical therapy delivers drug concentrations 100-1000 times higher than systemic antibiotics at the infection site in patients with a ruptured eardrum 1, 2

Aminoglycoside-containing drops, such as neomycin, gentamicin, and polymyxin B-neomycin combinations, should be avoided in patients with a ruptured eardrum due to the risk of severe permanent sensorineural hearing loss 1, 2
Alcohol-containing drops and cerumenolytics or irrigation should be avoided in patients with a ruptured eardrum due to the risk of further damage or ototoxicity 1, 2
Benzocaine otic solutions are not FDA-approved for middle ear use and should be avoided in patients with a ruptured eardrum 4

Systemic antibiotics should be reserved for specific indications, such as extension of infection beyond the ear canal, host factors, or failure to improve within 48-72 hours despite adequate topical therapy 1, 2
Amoxicillin or amoxicillin-clavulanate can be used as first-line therapy, while fluoroquinolones, such as ciprofloxacin or levofloxacin, can be used as alternative therapy in patients with a ruptured eardrum and signs of infection 2, 5

Patients with a ruptured eardrum should be reassessed at 48-72 hours if no improvement occurs 1, 3
Adherence to therapy and proper drop administration technique should be evaluated, and further aural debridement or suctioning may be necessary in patients with a ruptured eardrum 1, 3

Surgical repair may be necessary for patients with a ruptured eardrum that persists beyond 6 months, blast injury mechanism, suspected ossicular chain damage, immediate complete facial nerve paralysis, or perilymphatic fistula 2
Novel surgical adjuvants, such as basic fibroblast growth factor with gelatin sponge, may be used to promote healing in patients with a ruptured eardrum 2