What Is a Perforated Eardrum?
A perforated eardrum is a tear or a hole in the membrane (eardrum) that divides the outer ear canal and the middle ear. This translucent membrane receives sound vibrations and transmits them to the tiny bones (ossicles) in the middle ear, the initial step in the process of converting sound waves to nerve impulses. Consequently, when the eardrum is perforated or ruptured, hearing is temporarily compromised.
Additionally, a ruptured eardrum provides greater opportunity for bacteria to enter and infect the middle ear. With prompt medical treatment, small perforations generally heal on their own within a month or two. Larger punctures and those that do not heal within three months may require microsurgery to repair or rebuild the eardrum. Once an eardrum is healed, there is usually little or no residual hearing loss provided that the ossicles have not been damaged.
What Causes a Perforated Eardrum?
- A severe middle ear infection (otitis media) may erode the eardrum or cause it to burst.
- Inserting an object (a cotton swab, paper clip, etc.) into the ear may perforate the eardrum.
- A sudden increase or decrease in the air pressure in the outer ear canal relative to that of the middle ear may cause the eardrum to rupture (barotrauma). Changes in pressure strong enough to rupture the eardrum may be caused by a nearby explosion or a blow to the ear (such as a slap to the head or direct force from water contact such as occurs during diving or water skiing). Scuba diving or flying may also cause a pressure change strong enough to injure the eardrum.
Symptoms of Perforated Eardrum
- Earache or sudden pain in the ear
- Partial hearing loss
- Slight bleeding or discharge from the ear. Pain associated with infection may ease as built-up fluid is released.
- Ringing or buzzing in the ear (tinnitus)
Prevention of Perforated Eardrum
- Do not insert objects, even cotton swabs, into the ear canal, and you should not attempt to clean the ear with alcohol or over-the-counter solutions. If impacted earwax interferes with hearing or causes discomfort, allow your doctor to remove it safely.
- Do not swim in polluted waters, which can cause ear infections.
- Get prompt treatment for ear infections.
- Avoid scuba diving (and flying if possible) when you have an allergy, cold, or throat infection.
Diagnosis of Perforated Eardrum
- The doctor will examine the eardrum through an otoscope, a small, lighted viewing instrument.
- If trauma or severe force has caused the perforation, x-rays of the temporal lobe and skull should be taken to detect a possible fracture.
How to Treat a Perforated Eardrum
- If you suspect a ruptured eardrum, see a doctor. In the meantime, cover the affected ear with a clean, dry pad to discourage infection. Take an over-the-counter pain reliever if necessary. Children should not be given aspirin and should take acetaminophen instead.
- Your doctor may prescribe antibiotics to treat or prevent infection in the middle ear.
- If the ear is bleeding, use a sterile, cotton-tipped applicator to absorb the blood. Your doctor will check for purulent drainage or evidence of cerebrospinal fluid leakage.
- A warm heating pad or towel may be placed over the ear to relieve pain.
- Keep the eardrum dry as it heals. Protect the ear in the shower and when washing your hair; avoid swimming. An ear patch may be recommended for daytime use.
- If the eardrum fails to heal on its own, it may be surgically repaired with a tissue graft (myringoplasty or tympanoplasty).
When to Call a Doctor
- Call a doctor if you experience symptoms of a ruptured eardrum.
- Consult an otolaryngologist (ear, nose, and throat specialist) if normal hearing is not restored within a month following a ruptured eardrum.
Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference
Simeon Margolis, M.D., Ph.D., Medical Editor
Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50
Updated by Remedy Health Media