Ear Drops With a Perforated Eardrum: What Is Safe
If you think you have a perforated eardrum, do not put drops in your ear unless a doctor has told you to. The NHS advises against putting anything in the ear, including cotton buds or eardrops, unless a doctor recommends it. Some drops can harm the inner ear when there is a hole in the drum, so the right drop depends on a clinician looking at your ear first. If wax is part of the picture, a regulated clinician can examine the ear before any treatment. At EARS Clinics, treatment is carried out by NHS-accredited Aural Care Specialists in Glasgow and Edinburgh.
TL;DR
Do not use over-the-counter or leftover ear drops with a suspected perforated eardrum. Use only drops a doctor has prescribed for your ear.
Some prescribed drops, such as those containing aminoglycosides or polymyxins, are contraindicated with a perforation or grommet except under specialist direction.
Keep the ear dry: no swimming until it heals, and use cotton wool covered in petroleum jelly when washing your hair.
Most perforations heal on their own within about two months. Sudden hearing loss, discharge or worsening hearing needs an urgent GP appointment or NHS 111.
If you have wax and a history of perforation, tell the practitioner before any treatment, so the safest method is chosen for you.
Why ear drops and a perforated eardrum do not mix
The eardrum is a thin membrane that separates the ear canal from the middle ear. When it has a hole, anything you put into the canal can pass through into the middle ear, where the delicate structures of hearing and balance sit. Water, soap, oil and medicines all behave differently there than they do in the canal.
That is why NHS guidance for a perforated eardrum is cautious. As well as keeping cotton buds out, the NHS says not to swim or get your ear wet until the eardrum heals, and it describes drops as something to use only when a doctor recommends them. A perforation can follow an ear infection, a sudden pressure change, an injury, or poking something into the ear. Often the person does not know it has happened.
The most common signs are sudden ear pain that eases quickly, discharge, reduced hearing, ringing, or a feeling that the ear is blocked. Many of those overlap with wax blockage or infection, which is exactly why guessing and reaching for the bathroom cabinet is risky. Our guide to warning signs of ear problems explains how to tell when a symptom needs checking.
Which drops are used, and which are avoided
Prescribers follow detailed formulary guidance here. You do not need to memorise it, but understanding it explains why a pharmacy shelf product is the wrong choice. The points below come from NHS formularies in England.
Type of drop | What the guidance says |
Aminoglycoside or polymyxin drops | Contraindicated with a perforated eardrum or patent grommet. ENT specialists may consider them for obvious infection in chronic suppurative otitis media, or when other measures have failed for otitis externa, for no longer than 2 weeks. |
Certain combination drops (for example ciprofloxacin with dexamethasone, or products containing neomycin or gentamicin) | The South and West Devon guidance says several named products should not be used with a perforated tympanic membrane without specialist advice. |
Ciprofloxacin 0.3% with dexamethasone 0.1% | The Derbyshire formulary lists it as usable in children with acute otitis media and grommets or perforation, and in adults and children over 6 months, as a prescribed treatment. |
Phenazone with lidocaine (pain-relief drops) | The same Derbyshire formulary says they should only be used if there is no eardrum perforation or discharge. |
Two things stand out. First, the same drop can be right for one ear and wrong for another, depending on whether the drum is intact. Second, the decision belongs to a prescriber. The Derbyshire formulary also notes that manufacturers contraindicate topical aminoglycosides in a perforated drum because of reports of ototoxicity, meaning damage to hearing or balance. It cites an MHRA warning from January 2021 about a raised risk of deafness from aminoglycosides in people with certain mitochondrial mutations.
Drops for infection after a perforation
When a perforation comes with a discharging ear, NHS guidance in North and East Devon sets out the usual route. For acute infection with a perforation, keep the ear dry, protect it from soap, shampoo and water, and do not swim until the review. Primary care reviews the ear at 6 weeks to check the eardrum looks normal. For persistent discharge with no other symptoms, a topical quinolone drop may be considered.
For chronic suppurative otitis media, the same guidance describes topical antibiotic and steroid drops with pain relief, plus general advice: do not poke the ears, do not clean the canals with cotton buds, and keep the ear protected from water.
The Rotherham NHS Foundation Trust adds a useful point: if there is an infection, a perforation will not heal until the infection clears, so prescribed antibiotic drops matter. That is a reason to get the right drops quickly, not to improvise.
What about wax-softening drops?
Wax drops and oils are the products people most often reach for, and they are the ones most likely to be used by mistake in an ear that has a hole. Do not use any drop to soften wax if you have symptoms of a perforation or have been told you have one. If wax is blocking the ear and you have a history of perforation, grommets or ear surgery, say so at the start of the appointment. Our article on essential ear safety and wax removal explains why trained, regulated care matters.
Keeping the ear dry: showering, hair washing and swimming
The reader who types a question about swimming and ear drops usually wants a practical answer. It is this: with a perforation, the plan is to keep water out entirely until the drum has healed.
Swimming. The NHS says not to swim or get your ear wet until the eardrum heals. Airedale NHS Trust gives the same advice for a burst eardrum and says healing usually takes around 6 weeks. If you are using prescribed drops, the Coventry and Warwickshire ENT leaflet says to wait until the course is finished before swimming, and to check with a doctor or nurse first so it does not harm the ears.
Where a clinician has said water activity is acceptable, for example with grommets, the Royal Devon trust’s water precautions leaflet advises no diving, jumping in or swimming underwater, with or without ear protection. It recommends a swimming cap or protective ear bands alongside the cotton wool and Vaseline method.
Showering and washing hair. The NHS recommends a large piece of cotton wool covered in petroleum jelly placed in the outer ear to stop water getting in. The Royal Devon leaflet gives the detail:
Take a small piece of cotton wool and dip it in Vaseline.
Place it in the bowl of the ear so it covers the opening of the ear canal.
Add more Vaseline on top with a clean finger.
Shower and wash your hair, then remove it afterwards.
The leaflet notes it is the Vaseline that makes the seal waterproof, and cotton wool alone soaks up water. Do not push the plug into the canal itself. Sheffield Teaching Hospitals’ ENT FAQ also says to use good earplugs for swimming but avoid wearing them excessively when you are not swimming.
If you simply have water stuck in the ear and no suspected perforation, see our guides to ear blocked after swimming and home remedies for water in your ear. If you suspect a perforation, follow the dry-ear rules above and have the ear checked.
How long a perforated eardrum takes to heal
The NHS says a perforated eardrum usually gets better on its own within 2 months. You may need antibiotics if you have an ear infection, or to stop one developing while the drum heals. If the eardrum is not healing by itself, surgery called myringoplasty may be needed. Rotherham puts typical healing at 6 to 8 weeks and says that if the hole does not close, a referral to ENT can discuss options such as an operation to repair it.
In practice that means a perforation needs a plan: a diagnosis, protection from water, treatment of any infection and a follow-up check. Over-the-counter drops do not form part of that plan.
When to get medical help
A perforated eardrum is not usually an emergency, but some situations need prompt action. The NHS advises an urgent GP appointment or NHS 111 for:
sudden hearing loss in one or both ears
hearing that has worsened over the last few days or weeks
hearing loss with earache or ear discharge
The Airedale advice sheet also lists reasons to seek further medical advice: symptoms not improving after 3 days, drooping of the face, rapidly worsening symptoms, or severe headache despite adequate pain relief. Facial drooping or severe headache with an ear problem calls for urgent medical attention, not a wait-and-see approach. Our piece on why urgent ear care matters covers the same ground in plain language.
If your GP or an ENT specialist has prescribed drops, follow the instructions on the label and the dose and duration they gave you. Do not carry on with leftover drops from an earlier infection.
If wax and a perforation overlap
Wax and perforation often turn up together: a blocked, muffled ear, or a clinician who wants a clear view of the drum. This is where who treats you matters. Ear care should only be carried out by trained, competent clinicians following best practice, in a service regulated by Healthcare Improvement Scotland (HIS) or the Care Quality Commission (CQC) in England.
Three methods are used in clinical practice: microsuction, irrigation and manual instrumentation. Current NICE guidance prefers microsuction, while irrigation and manual instrumentation remain safe and clinically valid when appropriate. The practitioner chooses the safest and most suitable procedure for each patient, based on medical history and what they see in the ear. That is why your history of perforation, grommets, ear surgery or recurrent infections is the first thing a clinician needs to know.
Our perspective
We see the same pattern in the questions people ask about drops: they want something quick for a blocked, sore or muffled ear, and the shelf is full of products. A perforation changes the rules. The safest first step is to have the ear looked at by someone trained to examine it. That is how we work at EARS Clinics. We are registered with Healthcare Improvement Scotland and licensed and regulated to treat patients from 2 years of age. Our specialists are NHS-accredited Aural Care Specialists, and they choose between microsuction, irrigation and manual instrumentation according to your history and what they find in the ear. If your ear is simply blocked with wax, you should not have to wait weeks for a safe, regulated appointment. We offer same-day appointments, no pre-treatment preconditions, and before and after imaging so you can see what was done. Where your GP or ENT needs to know, we provide clinical correspondence. Tell us about any perforation, grommets or ear surgery when you book. It shapes the care you get. EARS
Book ear wax removal with EARS Clinics
If wax is the problem, you can book ear wax removal with EARS Clinics in Glasgow or Edinburgh. Appointments cost £60 for over-18s and £75 for under-18s, and a home visit within 20 miles of Glasgow is £180. You can pick a time on our online booking page.
Need it sooner? See same-day ear wax removal, or read what to expect at an appointment. Parents can find details on children’s ear wax removal. If you cannot travel, we also offer home visits.
If you have sudden hearing loss, discharge with pain, or any of the red-flag symptoms above, speak to your GP or NHS 111 first.
FAQ
Can you use ear drops on a perforated eardrum?
Only if a doctor has prescribed them for your ear. The NHS says not to put anything in the ear, including eardrops, unless a doctor recommends it. Some drops are contraindicated with a perforation, so over-the-counter or leftover drops are not a safe choice.
Can you swim with a perforated eardrum?
No. The NHS says not to swim or get the ear wet until the eardrum heals, which commonly takes around 6 to 8 weeks. When you are using prescribed drops, wait until the course is finished and check with your doctor or nurse before getting back in the water.
How do I keep water out of my ear in the shower?
Place a piece of cotton wool coated generously in petroleum jelly over the opening of the ear canal, in the bowl of the outer ear. The jelly makes the seal waterproof, and plain cotton wool just soaks up water. Do not push anything into the canal.
Is a perforated eardrum an emergency?
Usually not, as most heal by themselves. But sudden hearing loss, hearing that is getting worse, or hearing loss with earache or discharge needs an urgent GP appointment or NHS 111. Facial drooping or severe headache needs urgent medical attention.
Can I have ear wax removed if I have had a perforated eardrum?
Tell the practitioner about any perforation, grommets or ear surgery before treatment. At EARS Clinics, the specialist selects the safest and most suitable method for you based on your medical history and what they see in the ear.
Sources
Management of otitis externa, South and West Devon Formulary Guidance
Management of discharging ear, North and East Devon Formulary Guidance
Advice for people using ear drops, University Hospitals of Coventry and Warwickshire
Water precautions for ears, Royal Devon University Healthcare NHS Foundation Trust
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