Ear Drum Perforation

Ruptured Eardrum
Also known as Tympanic membrane perforation, Perforated eardrum is an opening, tear or hole in the tympanic membrane (eardrum).

 Causes, incidence, and risk factors

The tympanic membrane (eardrum) separates the outer ear from the middle ear. The eardrum vibrates when sound waves strike it.

The sound is conducted to tiny bones inside the middle ear that help to amplify the sound into the inner ear where nerve endings send a nerve impulse that travels to the brain. When the eardrum is damaged, the hearing process is interrupted.

Ear infections may cause a ruptured eardrum, more often in children. The infection causes pus or fluid to build up behind the eardrum. As the pressure increases, the eardrum may break open or rupture.

Damage to the eardrum can also occur from:

  • A very loud noise (acoustic trauma)
  • Difference in pressure between the inside and outside of the eardrum (barotrauma), which may occur when flying, scuba diving, or driving in the mountains
  • Foreign objects in the ear
  • Inserting cotton-tipped swabs or small objects into the ear to clean them
  • Trauma to the ear (such as a powerful slap or explosion)

Symptoms

  • Drainage from the ear (drainage may be clear, pus, or bloody)
  • Ear noise/buzzing
  •  Earache or ear discomfort
    • May be severe and increasing
    • There may be a sudden decrease in ear pain followed by ear drainage
  • Facial weakness or dizziness (in more severe cases)
  • Hearing loss in the affected ear (hearing loss may not be complete)

Signs and tests
The doctor will look in your ear with an instrument called an otoscope. If the eardrum is perforated, the doctor will see an opening in it, and may even see the bones of the middle ear.  Sometimes it is hard for the doctor to see the eardrum because of drainage (pus) from the ear.  Audiology testing can measure the extent of hearing loss.

Treatment
The goal of treatment is to relieve pain and prevent or treat infection.

Putting warmth on the ear may help relieve discomfort. Keep the ear clean and dry while it is healing. Place cotton balls in the ear while showering or shampooing to prevent water from entering the ear. Avoid swimming or putting your head underneath the water.

Antibiotics (oral or ear drops) may be used to prevent infection or to treat an existing infection. Analgesics (painkillers), including over-the-counter medications, may be used to relieve pain.

Sometimes the doctor may place a patch over the eardrum to encourage healing. Surgical repair of the eardrum (tympanoplasty) may be needed if the eardrum does not heal on its own.

What to expect from an ear drum perforation?

A ruptured or perforated eardrum may be uncomfortable, but it usually heals by itself within 2 months. Any hearing loss is usually temporary.

Complications

  • Ear infection (otitis media): The eardrum prevents bacteria from entering the middle ear. When the eardrum is ruptured, bacteria can easily travel to the middle ear, causing an infection.
  • Permanent hearing loss
  • Spread of infection to the bone behind the ear (mastoiditis)

When should I call my doctor?

  • Have symptoms of a ruptured or perforated eardrum
  • Are diagnosed with a ruptured eardrum, and symptoms last longer than 2 months despite medical treatment
  • Are diagnosed with a ruptured eardrum and develop ear drainage, a persistent fever, general ill feeling, or hearing loss

Prevention
Do not insert objects into the ear canal, even to clean it. Foreign objects should only be removed by a physician. Have ear infections treated promptly.