If the child presents with otorrhea, treatment is the same as AOM without perforation, but need to reassure parents that resolution doesn't differ and there are no long term complications. Studies have shown that parental satisfaction is not dependent on getting a prescription for antibiotics Complications Hearing Loss- usually conductive and temporary. There have been rare cases of sensorineural hearing loss. If have adhesion of drum, tympanosclerosis, or ossicle changes, may have permanent loss of hearing. Use same antibiotics as without perforation.
Perforations usually heal by themselves.
If there is a chronic perforation, may need surgical repair but this is uncommon. There is an odorous chronic drainage. There may be bony destruction and invasion of the cranium. With most cases of AOM, there will be inflammation of the mastoid air cell. May develop periostitis of the mastoid and have the ear pushed out and redness and tenderness over the mastoid.