Ear Drum Damage: Causes, Symptoms and Treatment

What the eardrum does

The eardrum is a cone-shaped membrane about 1 cm (0.4 inch) across, thinner than a sheet of paper. Sound waves make it vibrate, and three tiny bones in the middle ear pass those vibrations to the inner ear. It also forms a barrier that keeps water and bacteria out of the middle ear.

Damage to it takes several forms:

Our eardrum perforation page covers the hole itself in more detail.

Ear drum damage causes

• Middle ear infection: pus builds up behind the drum until it bursts. Severe pain is often followed by sudden relief and discharge. This is the most common cause, especially in children. See otitis media.
• Pressure changes: barotrauma from flying with a cold, scuba diving or a blow to the ear.
• Direct trauma: cotton swabs, hairpins, pencils or other objects pushed into the ear.
• Sudden loud noise: an explosion or gunshot close by can tear the drum and damage the inner ear. See acoustic trauma.
• Slap or blow: a cupped-hand slap over the ear, a fall onto water, or a sports injury.
• Head injury: a skull base fracture can tear the drum.
• Medical procedures: a hole may stay after an ear tube (grommet) falls out.
• Chronic Eustachian tube problems: long-term negative pressure causes retraction pockets, which can trap skin and form a cholesteatoma.

Symptoms of damage to the ear drum

• sharp ear pain at the moment of injury, which often eases quickly
• muffled or reduced hearing in that ear
• ringing or buzzing (tinnitus)
• clear, bloody or pus-like fluid draining from the ear
• a whistling sound when blowing the nose
• dizziness or spinning, which suggests the inner ear is also affected
• recurrent ear infections or a constant discharge with a long-standing hole

Small holes can cause almost no symptoms and are found only during an ear exam.

How it is diagnosed

A doctor looks into the ear with an otoscope. They can usually see the hole, its size and position, and whether there is infection. Further tests:

• Tympanometry: measures how the eardrum moves with pressure changes; a hole gives a flat trace.
• Hearing test (audiogram): shows how much hearing is lost and whether it is the conductive type (sound not passing through) or nerve damage.
• Microscope exam by an ENT specialist, and a CT scan if cholesteatoma or bone damage is suspected.

Treatment

Letting it heal

Most traumatic and infection-related perforations heal on their own:

• Keep the ear dry. Plug it when showering with a cotton ball coated in petroleum jelly, and avoid swimming until a doctor confirms it has healed.
• Do not put anything in the ear, including drops, unless prescribed. Some ear drops can damage the inner ear when the drum is open.
• Pain relief: acetaminophen (paracetamol) or ibuprofen, following the label dose.
• Avoid blowing your nose hard and flying or diving until healed.

Medicines

Antibiotic ear drops that are safe with a perforation, or oral antibiotics, are used when there is infection or a risk of it, such as after a dirty injury.

Procedures and surgery

• Paper patch: a small patch placed over the hole in the office to help it close.
• Myringoplasty or tympanoplasty: surgery to graft tissue over the hole, usually if it has not healed after about 3 months or causes recurrent infection and hearing loss. Success rates are high.
• Surgery to remove a cholesteatoma or repair the hearing bones if they are damaged.

Complications

• conductive hearing loss, which usually recovers when the drum heals
• repeated middle ear infections and chronic discharge through a persistent hole
• cholesteatoma, a growth of skin in the middle ear that slowly erodes bone
• permanent nerve hearing loss or vertigo if a blast or trauma also damaged the inner ear

Preventing eardrum damage

• Do not put cotton swabs or objects into the ear canal. The ear cleans itself.
• Treat ear infections promptly, especially in children.
• Avoid flying or diving with a heavy cold. Swallow, yawn or chew during descent.
• Wear hearing protection near loud noise such as gunfire or fireworks.

Frequently asked questions

What are the symptoms of a damaged eardrum?

Typical symptoms are sudden ear pain, muffled hearing, ringing, and fluid, blood or pus draining from the ear. Some people feel dizzy. With a middle ear infection, severe pain often eases suddenly when the drum bursts and the pressure is released.

How long does a damaged eardrum take to heal?

Most perforations heal within a few weeks, and nearly all small ones within 6 to 8 weeks. Large holes, those caused by long-term infection, and those after blasts may not close on their own and can need a patch or surgery.

Can a ruptured eardrum cause permanent hearing loss?

Usually not. Hearing normally returns once the eardrum heals. Permanent loss is more likely with large or long-standing holes, damage to the hearing bones, cholesteatoma, or when a blast or head injury also damages the inner ear.

Can I fly with a perforated eardrum?

Often yes, because pressure equalizes through the hole, so flying may be less painful than usual. Still, check with your doctor first, especially if you have an active infection, a cold or recent ear surgery. Avoid diving until the drum has healed.

Should I use ear drops with a perforated eardrum?

Only drops prescribed by a doctor who knows the drum is perforated. Some over-the-counter and prescription drops can reach the inner ear through the hole and damage hearing or balance.