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Antibiotic prophylaxis in traumatic perforation of the tympanic membrane

Three Part Question

In patients with [traumatic perforation of the tympanic membrane] are [prophylactic antibiotics] indicated to [reduce the complication rate].

Clinical Scenario

You are on duty in the Emergency Department when you see a 20 year old woman who has perforated her left tympanic membrane with a cotton bud. You wonder if the ENT SHO is right when he suggests prophylactic antibiotics.

Search Strategy

Medline 1966 – 9/2/09. Using the OVID interface
[Tympanic OR Ear OR exp.Tympanic membrane perforation]LIMIT to English AND Human
AND [ OR exp.antibacterial agent]

Search Outcome

244 papers found of which none were relevant


All studies of perforated TMs routinely used prophylactic antibiotics of some description.

Clinical Bottom Line

There is no evidence comparing prophylactic antibiotics with no treatment and so local guidelines should be followed.