The hearing loss is more severe if the ossicular chain is disrupted or the inner ear injured. Vertigo suggests injury to the inner ear. Purulent otorrhea may begin in 24 to 48 h, particularly if water enters the middle ear. Treatment Many perforations can be monitored without the need for medical treatment. If infection is present or considered likely to occur, oral penicillin V 250 mg q 6 h should be given for 7 days.
Aseptic technique is used when examining the ear.
If possible, the displaced flaps of tympanic membrane are placed in their original positions, using local anesthetics and microscopic control, to facilitate healing. The ear is kept dry. Spontaneous closure of the perforation is usual, but if it does not occur within 2 mo, repair of the tympanic membrane is indicated. If a conductive hearing loss persists, suggesting discontinuity of the ossicular chain, the middle ear should be explored surgically and repaired. A sensorineural hearing loss or vertigo that persists for hours or longer after the injury may result from inner ear concussion but may also indicate penetration of the inner ear, which requires a prompt exploratory tympanotomy to assess and repair the damage as soon as possible.