HomeAnswersOtolaryngology (E.N.T)ruptured eardrumWill eardrum perforation due to barotrauma on using suction heal on its own?

Is surgery necessary for otitis media induced eardrum perforation?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

Dr. Vinodhini J.

Published At August 19, 2020
Reviewed AtOctober 6, 2023

Patient's Query

Hello doctor,

I have otitis media induced perforation. Perforation is caused as well by barotrauma and by using suction mistakenly thinking as the earwax is causing discomfort. Does perforation of this size require surgical repair? Or will it heal on its own over time? See photos from the otoscope. I am currently on Amoxicillin and Clavulanic acid, and Ofloxacin ear drops.

Hi,

Welcome to icliniq.com.

I went through the photos you send (attachment removed to protect patient identity). However, both the photos are not very clear and the tympanic membrane is not clearly visualized. There are various aspects we take into consideration before a patient is chosen as an ideal candidate for myringoplasty surgery (repair of the eardrum). 1. A long-standing perforation which has been there for more than two years and in addition if the ear has been dry almost always, there is less than 50 % chance that the eardrum will close on its own. 2. A traumatic perforation usually has excellent healing rates of over 90 percent and in my opinion, does not require surgery. The healing usually occurs in six to eight weeks time in most people. There is no requirement to take antibiotics as well in such a scenario unless there has been an infection associated with ear discharge. 3. Size of the perforation is also something which we consider to be a deciding factor. If the perforation size involves 75 % area of the eardrum or more. It is considered to be large central, subtotal, total perforation and the ability of the body to spontaneously close such perforations is less than 10%. 4. Ear discharge is another criteria that we look into. If there has been persistent ear discharge, it indicates some pathology in the middle ear cleft and in such a scenario, the eardrum will almost never close unless the middle ear pathology is attended and treated accordingly. General instructions are 1. Always avoid using earbuds/q-tips as they are always more problem creating rather than giving any benefit. 2. Keep the ear dry. Wear a shower cap while taking a head bath. 3. Do not try to fiddle around with the ear using an instrument as it can keep infecting the canal. 4. Antibiotics and eardrops only to be taken under the supervision of a certified physician /surgeon and never treat yourself. 5. Make sure that the antibiotic course is completed as prescribed even if you feel completely fine and better after a couple of days of initiating the course. I hope this helps.

Patient's Query

Thank you doctor,

I have attached one more otoscope image cropped just at the eardrum. I realize the image quality is poor, but I cannot provide better. However, it appears that the perforation is circular and in the center of the tympanic membrane. I would estimate 50% of the membrane is perforated. My hearing level is still decent in that ear maybe 75% of normal. Discharge has stopped with antibiotic therapy. Given this additional information, what is the chance this perforation will heal without surgery over eight weeks or so?

Hi,

Welcome back to icliniq.com.

I have seen the image (attachment removed to protect patient identity). If around 50% of the eardrum is involved and if the ear is kept dry with no discharge coming out, there is a more than 65 to 70 percent chance of spontaneous closure in the next eight weeks time. Please understand that this is an average time duration based on observations we make and is not specific for everyone. Sometimes the eardrum might take as long as four to six months to heal on its own. This is why it is worthwhile to wait until then without undergoing any procedure or intervention in a hurry. Until the perforation closes, there will be some associated ringing sensation, heaviness, and reverberation of sound as a distorted eardrum will interfere with sound conduction, processing, and transmission. Make sure you do not have any nasal allergies or inflammations going on in the nose as that can also be one of the factors causing a delay in healing of the eardrum and its associated structures. There is absolutely nothing that you need to worry about as things should shape up and normalize slowly with time to come.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Bhadragiri Vageesh Padiyar
Dr. Bhadragiri Vageesh Padiyar

Otolaryngology (E.N.T)

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