Eardrum Perforation
A hole or tear in the eardrum from infection, injury, or pressure changes
Quick Facts
- Type: Ear injury
- Common causes: Ear infection, injury, loud noise, pressure
- Main symptoms: Ear pain, drainage, hearing loss
- Healing: Often heals on its own within weeks
Overview
An eardrum perforation is a hole or tear in the tympanic membrane, the thin layer of tissue that separates the outer ear canal from the middle ear. This membrane vibrates in response to sound and also protects the delicate middle ear from water and germs.
When the eardrum is perforated, hearing can be reduced and the middle ear becomes more vulnerable to infection. Perforations are commonly caused by ear infections, injury, sudden pressure changes, or loud noise. Many small perforations heal on their own within a few weeks, but some require treatment or repair.
Symptoms
Symptoms can range from barely noticeable to clearly distressing, and sometimes a perforation causes pain that suddenly eases as fluid drains.
- Sudden, sharp ear pain or discomfort that may then ease
- Drainage from the ear, which may be clear, pus-like, or bloody
- Hearing loss in the affected ear, often partial
- Ringing or buzzing in the ear (tinnitus)
- A spinning sensation (vertigo) or dizziness
- A feeling of fullness in the ear
If a perforation follows a head injury or a very loud blast and is accompanied by severe dizziness, facial weakness, or significant bleeding, prompt evaluation is needed.
Causes
The eardrum can be perforated by infection, injury, or pressure. Common causes include:
- Middle ear infections: Fluid and pressure can build up behind the eardrum and cause it to rupture.
- Injury from objects: Inserting cotton swabs, pins, or other items into the ear.
- Sudden pressure changes (barotrauma): From flying, scuba diving, or a blow to the ear.
- Loud noise or blast: An intense sound wave can tear the membrane.
- Head or ear trauma: Including a skull fracture or a slap to the ear.
Inserting objects into the ear is a frequent and avoidable cause, which is why the common advice is to never put anything smaller than your elbow into your ear.
Risk Factors
- Frequent or untreated middle ear infections
- Using cotton swabs or other objects to clean the ears
- Activities with rapid pressure changes, such as flying or diving
- Exposure to very loud noise or explosions
- Head or ear injuries
- Being a young child, who are more prone to ear infections
Diagnosis
A perforated eardrum is usually diagnosed with a simple examination of the ear, sometimes with additional hearing tests.
- Otoscopy: The doctor looks into the ear canal with a lighted instrument (otoscope) to see the perforation directly.
- Tuning fork or hearing tests: To measure how much hearing has been affected.
- Tympanometry: A test that checks how the eardrum responds to pressure.
- Ear culture: If there is drainage, a sample may be taken to identify infection.
Treatment
Many eardrum perforations heal without specific treatment, but care is aimed at relieving symptoms, preventing infection, and protecting the ear while it heals.
- Keeping the ear dry: Avoiding water entry helps prevent infection during healing.
- Antibiotics: Ear drops or oral antibiotics if there is an infection.
- Pain relief: Over-the-counter pain medicines and warm compresses.
- Patching: A specialist may place a paper or gel patch to help a stubborn perforation close.
- Surgery (tympanoplasty): To repair perforations that do not heal on their own or are large.
Most small perforations heal within a few weeks. Avoid putting anything in the ear and keep water out while it recovers.
Prevention
- Do not insert cotton swabs or other objects into the ear canal
- Treat ear infections promptly
- Protect your ears from very loud noise and blasts
- Equalize ear pressure when flying or diving by swallowing, yawning, or gentle techniques
- Avoid flying or diving with a heavy cold or ear infection when possible
- Wear ear protection in noisy environments
When to See a Doctor
See a doctor if you have sudden ear pain, drainage, hearing loss, or a sensation that something has changed in your ear, especially after an infection, injury, or pressure change.
Seek prompt or emergency care if you have severe dizziness or loss of balance, significant bleeding from the ear, facial weakness, or a perforation following a serious head injury, as these may indicate more extensive damage that needs urgent evaluation.
Frequently Asked Questions
Will a perforated eardrum heal on its own?
Many small perforations heal by themselves within a few weeks. Keeping the ear dry and avoiding inserting anything into it helps healing. Larger or persistent perforations may need a patch or surgical repair.
Does a perforated eardrum cause permanent hearing loss?
Usually not. Hearing loss from a perforation is often partial and improves as the eardrum heals. Repeated or large perforations and untreated infections can have a longer-lasting effect, so follow-up is recommended.
Can I fly or swim with a perforated eardrum?
It is best to avoid getting water in the ear and to be cautious with flying and diving until the eardrum has healed, because water can introduce infection and pressure changes can cause discomfort. Ask your doctor when it is safe to resume these activities.
How is a perforated eardrum diagnosed?
A doctor can usually see the perforation by looking into the ear with a lighted instrument called an otoscope. Hearing tests and a pressure test called tympanometry may be used to measure how much the perforation affects hearing.
Is it an emergency?
A simple perforation is not usually an emergency, but seek prompt care if it follows a serious head injury or is accompanied by severe dizziness, facial weakness, or heavy bleeding, as these may signal more extensive damage.
References
- American Academy of Otolaryngology–Head and Neck Surgery. Perforated eardrum.
- Mayo Clinic. Ruptured eardrum (perforated eardrum).
- MedlinePlus, U.S. National Library of Medicine. Perforated eardrum.
- National Institute on Deafness and Other Communication Disorders (NIDCD).