There are a number of causes of a perforated tympanic membrane including infections, trauma from a foreign object, barotrauma or head injury.
Symptoms include sudden ear pain, or sudden decrease in ear pain, discharge (which may be bloody) or hearing loss.
The vast majority of ruptured eardrums will heal without treatment.
A simple perforation of the ear drum as part of acute otitis media does NOT need referral unless it persists > 6 weeks.
TM perforations in children can take up to 2 years to heal
When to refer:
Refer after 6 weeks if the perforation or discharge persists
GP assessment and management
- A perforation associated with acute otitis media can be treated with oral antibiotics as for AOM
- Non-ototoxic, topical antibiotics such as Cilodex drops may be used in children if the perforation is associated with ear discharge
- Keep ear completely dry and review in 6 weeks
