ear, nose, and throat disorders
Traumatic Perforation of the Tympanic Membrane
Treatment of Traumatic TM Perforation
Dry ear precautions Topical antibiotics for contaminated injuries Sometimes surgery Often, no specific treatment is needed other than maintaining dry ear precautions. Dry ear precautions include occluding the external canal (eg, using a cotton ball lathered with petroleum jelly) while bathing and showering and avoiding swimming. Routine antibiotic ear drops are unnecessary. However, prophylaxis with antibiotic ear drops is necessary if contaminants may have entered through the perforation as occurs in dirty injuries. Although most perforations close spontaneously, surgery is indicated for a perforation persisting>2 months. Persistent conductive hearing loss suggests disruption of the ossicular chain, necessitating surgical exploration and repair. If the ear becomes infected,amoxicillin500 mg orally every 8 hours can be given for 7 days, however, typically topical therapy with fluoroquinolone ear drops (ciprofloxacinorofloxacin) alone is sufficient. Ear drops that contain aminoglycosides (eg,neomycin,tobramycin) or polymyxin should not be prescribed for patients with a perforated tympanic membrane or a tympanostomy tube because of potential ototoxicity. 