Do decongestants and/or antihistamines decrease the likelihood of tympanic membrane (TM) rupture? Once a TM ruptures, is it still safe to use Auralgan (antipyrine, benzocaine, glycerin dehydrated) and/or antibiotic drops?—DEBBIE CHRISTIAN, RN, BSN, MSN, ANP-BC, Ferguson, Mo.

There has been no evidence that decongestants are helpful either in preventing otitis media (OM) with upper respiratory infections or in preventing TM rupture in OM. Once the TM ruptures, the pain diminishes, and a topical analgesic is usually not necessary. Moreover, Auralgan is contraindicated in perforated TMs. Otic antibiotics, like ofloxacin otic 0.3% solution, work well in OM and associated TM rupture because these agents can get directly to the site of infection (the middle ear) quickly. The TM can heal quickly, so concomitant oral antibiotics may also be indicated. — Julee B. Waldrop, MS, PNP (144-5)