Perforated Eardrum
A perforated eardrum, also known as a tympanic membrane perforation, is a hole or tear in the thin tissue that separates your ear canal from your middle ear. This membrane plays an important role in hearing by vibrating when sound waves enter the ear canal. It also provides protection for the middle ear from water, bacteria, and other foreign substances. A perforation can occur due to infection, trauma, or pressure changes, and may cause symptoms including hearing loss, ear pain, and drainage. While many perforations heal on their own within weeks, some require medical intervention.
Causes
- Middle ear infections (otitis media) - Pressure from fluid buildup in the middle ear can cause the eardrum to rupture.
- Trauma - Injury from objects inserted into the ear (cotton swabs, hairpins, fingers), a blow to the ear, or a very loud noise (acoustic trauma) can tear the eardrum.
- Barotrauma - Pressure differences between the inside and outside of the eardrum, such as during air travel, scuba diving, or exposure to an explosion, can cause the eardrum to rupture.
- Chronic Eustachian tube dysfunction - Long-term problems with the tube that connects the middle ear to the back of the throat can lead to pressure imbalances that weaken the eardrum.
- Ear surgeries - Certain procedures involving the ear may involve intentional perforation or result in accidental perforation.
- Foreign objects - Small objects that become lodged in the ear canal can damage the eardrum.
- Cholesteatoma - An abnormal skin growth in the middle ear behind the eardrum that can damage the eardrum as it grows.
- Severe head trauma - Injuries to the head can cause pressure changes that rupture the eardrum.
Signs and Symptoms
- Ear pain that may subside quickly after the rupture occurs
- Hearing loss ranging from mild to moderate, depending on the size and location of the perforation
- Drainage from the ear - clear, pus-filled, or bloody
- Tinnitus (ringing or buzzing in the ear)
- Spinning sensation (vertigo)
- Nausea or vomiting related to vertigo
- Ear infection symptoms including fever and increased pain if bacteria enter through the perforation
- A feeling of fullness in the ear
- Increased sensitivity to loud noises
- Occasional ear itching during the healing process
Diagnosis
Otoscopy
Your doctor will use an otoscope (a lighted instrument) to examine your ear canal and eardrum. A perforation may be directly visible as a dark or light area on the eardrum, depending on what's behind it.
Pneumatic Otoscopy
This test uses a puff of air to see how well your eardrum moves. Limited or no movement can indicate a perforation or other middle ear problem.
Audiometry
A hearing test to determine the type and degree of hearing loss associated with the perforation. The pattern of hearing loss can help confirm the diagnosis and assess the impact on your hearing.
Tympanometry
This test measures how well your eardrum responds to slight pressure changes. It can help determine the size and location of the perforation.
Laboratory Tests
If there is drainage from the ear, your doctor may collect a sample to test for bacterial or fungal infection, which can help guide antibiotic treatment.
Treatment Options
Observation and Time
Many eardrum perforations, especially smaller ones, heal on their own within a few weeks to a few months. During this time, your doctor may recommend keeping the ear dry and avoiding swimming or submerging your head in water. You may be advised to place a cotton ball coated with petroleum jelly in your ear when showering.
Medications
If an infection is present, your doctor may prescribe antibiotics as ear drops or oral medication. Pain relievers can help manage discomfort. For perforations caused by Eustachian tube dysfunction, decongestants or nasal steroids might be recommended.
Eardrum Patching
For perforations that don't heal on their own, your doctor might apply a chemical or paper patch to the eardrum to stimulate healing. The patch acts as a scaffold for new tissue growth and is eventually absorbed or falls out as the eardrum heals.
Surgical Repair (Tympanoplasty)
For larger perforations or those that don't heal with other treatments, surgical repair may be necessary. Tympanoplasty involves using tissue from another part of your body (often taken from above the ear or from a vein) to create a graft that closes the perforation. This can be done through the ear canal or through an incision behind the ear, depending on the size and location of the perforation.
Home Remedies
Keep the Ear Dry
While the eardrum is healing, it's crucial to keep water out of the ear. Use earplugs or cotton balls coated with petroleum jelly when showering, and avoid swimming until your doctor confirms the perforation has healed.
Pain Management
Over-the-counter pain relievers like acetaminophen or ibuprofen can help manage ear pain. Always follow the dosage instructions and consult your doctor if you're unsure about which pain reliever is appropriate for you.
Avoid Blowing Your Nose Forcefully
Forceful nose blowing can cause pressure changes that affect the eardrum and potentially worsen a perforation. If you need to blow your nose, do so gently, one nostril at a time.
Avoid Air Pressure Changes
Until your eardrum has healed, try to avoid situations that involve significant pressure changes, such as air travel, scuba diving, or high-altitude locations. If air travel is necessary, consult your doctor for strategies to minimize risk.
Use Warm Compresses
Applying a warm, clean cloth to the outside of the ear can help relieve pain and promote healing by increasing blood flow to the area. Hold the compress against the ear for 10-15 minutes several times a day.
Preventive Care
- Seek prompt treatment for ear infections to prevent pressure buildup that could rupture the eardrum.
- Never insert objects into your ear, including cotton swabs, which can damage the eardrum.
- Protect your ears from loud noises by wearing earplugs or ear protection in very noisy environments.
- During air travel, stay awake during takeoff and landing to swallow, yawn, or chew gum, which helps equalize pressure in the ears.
- When diving or swimming, use proper techniques to equalize ear pressure and consider using earplugs designed for water activities.
- Manage allergies and sinus problems that can affect Eustachian tube function and lead to middle ear pressure problems.
- If you feel pain in your ear when changing altitude or diving, stop and return to a level where the pain subsides.
- For those prone to ear problems, consider avoiding extreme water sports or activities that involve significant pressure changes.
- Get regular check-ups with an ENT specialist if you have a history of ear problems.
- Avoid slapping or hitting the ears, which can cause sudden pressure changes and potential damage.
Surgical Options
Tympanoplasty
A surgical procedure to repair a perforated eardrum using a tissue graft, typically performed on an outpatient basis under local or general anesthesia. The surgeon may approach the eardrum through the ear canal or through an incision behind the ear, depending on the size and location of the perforation. Success rates are generally high, with 85-90% of procedures resulting in complete closure of the perforation and improved hearing.
Learn More About This ProcedureMyringoplasty
A less complex version of tympanoplasty that focuses specifically on repairing the eardrum without addressing the bones of the middle ear. This procedure is typically used for smaller, uncomplicated perforations and may be performed in the doctor's office under local anesthesia in some cases.
Learn More About This ProcedureTympanoplasty with Ossiculoplasty
For cases where a perforated eardrum is accompanied by damage to the middle ear bones (ossicles), this more extensive procedure repairs both the eardrum and reconstructs or replaces the damaged ossicles to restore the sound conduction mechanism of the middle ear.
Learn More About This ProcedureCartilage Tympanoplasty
A variation of tympanoplasty that uses cartilage (usually from the ear itself) instead of fascia (connective tissue) for the graft. This technique may be preferred for larger perforations or in cases where the Eustachian tube function is poor, as cartilage grafts are more rigid and resistant to negative middle ear pressure.
Learn More About This ProcedureSchedule a Consultation
If you're experiencing symptoms of perforated eardrum, our expert team is here to help you find the right treatment approach for your specific needs.