What is the most appropriate management for a small, clean tympanic membrane perforation?

The most appropriate management for a small, clean tympanic membrane perforation is to keep the ear dry. A small, clean perforation typically has a good chance of healing on its own, provided there is no infection or further irritation to the area. Keeping the ear dry helps to prevent water and other substances from entering the middle ear cavity, which could introduce bacteria or cause complications, potentially preventing the natural healing process.

Maintaining dryness is crucial because moisture can lead to infections, which may complicate or inhibit the healing of the perforation. By avoiding water exposure, especially while bathing or swimming, the patient increases the likelihood of the perforation closing naturally over time.

While using cotton balls in the ear may seem like a protective measure, it can sometimes lead to issues, as they may absorb moisture and could also risk further irritation or injury to the ear canal if not used carefully. Antibiotic drops are not routinely indicated unless there is a sign of infection, and surgical intervention is typically reserved for larger, symptomatic, or non-healing perforations, which does not apply in this case of a small, clean perforation.