Tympanic Membrane Perforation

Overview

The tympanic membrane, or eardrum, is the thin layer of tissue that separates the outer ear canal from the middle ear. It vibrates when sound waves reach it, which is an essential part of hearing, and it also protects the delicate middle ear from water and germs.

A perforation is a hole or tear in this membrane. Many perforations heal on their own within a few weeks, but some require treatment to prevent infection or to repair persistent holes. The effect on hearing depends on the size and location of the hole.

Symptoms

• Ear pain that may suddenly ease after the eardrum tears
• Drainage from the ear, which may be clear, bloody, or pus-like
• Hearing loss in the affected ear, usually partial
• Ringing in the ear (tinnitus)
• A spinning sensation (vertigo) or loss of balance in some cases

Some small perforations cause few symptoms and are found during an ear examination.

Causes

Common causes of a perforated eardrum include:

• Middle ear infection: Pressure from fluid and pus can build up and rupture the eardrum.
• Injury: Inserting cotton swabs or other objects, or a direct blow to the ear.
• Sudden pressure changes (barotrauma): From flying, scuba diving, or a slap to the ear.
• Loud blasts: An explosion or very loud sound near the ear.
• Severe head injury involving the ear or skull.

Risk Factors

• Frequent or untreated ear infections
• Use of cotton swabs or other objects in the ear canal
• Activities with rapid pressure changes, such as diving or flying with a cold
• Exposure to explosions or very loud noise
• Head trauma

Diagnosis

A doctor inspects the eardrum with a lighted instrument called an otoscope, which usually shows the hole directly. Additional tests may include:

• Hearing tests (audiometry): To measure how much hearing is affected.
• Tympanometry: To assess how the eardrum responds to pressure.
• A swab of any drainage if infection is suspected.

Treatment

Treatment depends on the cause and whether the hole heals on its own:

• Watchful waiting: Many perforations heal naturally within a few weeks to a couple of months.
• Keeping the ear dry: Avoiding water entering the ear during healing to prevent infection.
• Antibiotics: Oral or ear-drop antibiotics if there is an infection.
• Patching: A doctor may apply a paper patch to help a small hole close.
• Surgery (tympanoplasty): To repair a hole that does not heal or that causes ongoing hearing loss or infections.

Prevention

• Treat ear infections promptly
• Never put cotton swabs or other objects in the ear canal
• Equalize ear pressure when flying or diving, and avoid diving with a cold
• Use ear protection around loud noise and blasts

When to See a Doctor

See a doctor if you have ear pain, drainage, or hearing loss after an infection or injury, or if you suspect a hole in your eardrum. Seek prompt care for severe pain, bleeding from the ear, sudden major hearing loss, severe dizziness, or any ear injury after a serious head trauma or blast, as these may need urgent evaluation.

Related Topics

Frequently Asked Questions

References

1. Mayo Clinic. Ruptured eardrum (perforated eardrum).
2. American Academy of Otolaryngology-Head and Neck Surgery. Eardrum perforation.
3. MedlinePlus, U.S. National Library of Medicine. Perforated eardrum.