Ruptured eardrum (perforated eardrum)

Description

A rupture of the eardrum (tympanic membrane perforation) is a hole or tear in the thin tissue that separates the ear canal from the middle ear (eardrum).

A ruptured eardrum can result in hearing loss. You can also make your middle ear vulnerable to infections.

A ruptured eardrum usually heals within a few weeks without treatment. But sometimes it requires a hotfix, or a surgical repair to heal.

Symptoms

The signs and symptoms of a ruptured eardrum may include:

  • Ear pain that may decrease quickly
  • Mucuslike, pus-filled or bloody drainage from the ear
  • Hearing loss
  • Ringing in the ear (tinnitus)
  • Spinning sensation (vertigo)
  • Nausea or vomiting that may be the result of vertigo

When to see a doctor

Call your health care provider if you have signs or symptoms of a ruptured eardrum. The middle and inner ears are composed of delicate structures that are sensitive to injury or disease. It is important to try to find out the cause of the symptoms of the ear and to determine if a rupture of the eardrum has occurred.

Causes

Causes of a ruptured (perforated) eardrum may include:

  • Middle ear infection (otitis media). A middle ear infection often results in the accumulation of fluid in the middle ear. The pressure of these fluids can cause the eardrum to rupture.
  • Barotrauma.Barotrauma is stress exerted on your eardrum when the air pressure in the middle ear and the air pressure in the environment are out of balance. If the pressure is severe, your eardrum can rupture. Barotrauma is most often caused by air pressure changes associated with air travel. Other events that can cause sudden changes in pressure — and the possibility of a ruptured eardrum include diving, and a direct blow to the ear, such as the impact of an automobile air bag.
  • Loud sounds or explosions (acoustic trauma). A loud noise or explosion, such as an explosion or gunshot — essentially a mounting wave of sound — on rare occasions, can cause a rupture in the eardrum.
  • Foreign objects in the ear. Small objects, such as a cotton swab or fork can pierce or break the eardrum.
  • Severe head Trauma. Serious injury, such as a base of skull fracture can cause the dislocation or damage to the environment and the structures of the inner ear, including the eardrum.

Barotrauma. Barotrauma is stress exerted on your eardrum when the air pressure in the middle ear and the air pressure in the environment are out of balance. If the pressure is severe, your eardrum can rupture. Barotrauma is most often caused by air pressure changes associated with air travel.

Other events that can cause sudden changes in pressure — and the possibility of a ruptured eardrum include diving, and a direct blow to the ear, such as the impact of an automobile air bag.

Complications

The eardrum (tympanic membrane) has two main functions:

  • The hearing. When sound waves strike the eardrum vibrates — the first step to the structures of the middle and inner ears translate the sound waves into nerve impulses.
  • Protection. The eardrum also acts as a barrier, protecting the middle ear from water, bacteria and other foreign substances.

If the eardrum ruptures, rare problems can occur, especially if it fails to self-heal after three to six months. Possible complications include:

  • The hearing loss. Usually, hearing loss is temporary, lasting only until the tear or hole in your eardrum has healed. The size and location of the rupture can affect the degree of hearing loss.
  • Middle ear infection (otitis media). A ruptured (perforated) eardrum can allow bacteria to enter your ear. If a perforation in the eardrum does not heal, a small number of people can be vulnerable to the current recurrent or chronic) infections. In this small group, chronic drainage, and loss of hearing may occur.
  • Middle ear cyst (cholesteatoma).Although it is very rare, this cyst, which is composed of skin cells and other debris, can develop in the middle ear as a long-term result of the rupture of eardrum. Ear Canal debris normally travels to your outer ear with the help of ear-protecting earwax. If the eardrum is ruptured, the remains of the skin can happen in the middle ear and form a cyst. A cyst in the middle ear provides a favourable environment for bacteria and contains proteins that can cause damage to bones of the middle ear.

Middle ear cyst (cholesteatoma). Although it is very rare, this cyst, which is composed of skin cells and other debris, can develop in the middle ear as a long-term result of the rupture of eardrum.

Ear Canal debris normally travels to your outer ear with the help of ear-protecting earwax. If the eardrum is ruptured, the remains of the skin can happen in the middle ear and form a cyst.

A cyst in the middle ear provides a favourable environment for bacteria and contains proteins that can cause damage to bones of the middle ear.

Prevention

Follow these tips to avoid a ruptured (perforated) eardrum:

  • Get treatment for middle ear infections. Be aware of the signs and symptoms of middle ear infection, including earache, fever, nasal congestion and reduced hearing. Children with middle ear infections are often very demanding and may refuse to eat. Look for a quick assessment of your provider to avoid possible damage to the eardrum.
  • Protect your ears during the flight.If possible, do not fly if you have a cold or an allergy triggers that causes nasal or ear congestion. During takeoffs and landings, keep your ears clear with pressure-equalizing earplugs, yawning or chewing gum. Or use the Valsalva maneuver — gently pushing the air through the nose, as if blowing your nose, while pinching your nose and keep your mouth shut. Do not sleep during ascents and descents.
  • Keep your ears free of foreign objects. Never attempt to remove the excess or the wax hardened with items such as a cotton swab, paper clip or hairpin. These items can easily tear or perforation of the eardrum. Teach your children about the damage that can be done by putting foreign objects in the ears.
  • The guard against the deafening noise. Avoid activities that expose the ears to the explosions. If your hobbies or work involves planned activities that produce noise explosive, protect your ears from unnecessary damage by wearing protective earplugs or earmuffs.

Protect your ears during the flight. If possible, do not fly if you have a cold or an allergy triggers that causes nasal or ear congestion. During takeoffs and landings, keep your ears clear with pressure-equalizing earplugs, yawning or chewing gum.

Or use the Valsalva maneuver — gently pushing the air through the nose, as if blowing your nose, while pinching your nose and keep your mouth shut. Do not sleep during ascents and descents.

Ruptured eardrum (perforated eardrum)

Diagnosis

Your doctor or an ent specialist can often determine if you have a ruptured (perforated) eardrum with a visual inspection using a lighted instrument (an otoscope or microscope).

Your healthcare provider may conduct or order additional tests to determine the cause of your ear symptoms or to detect the presence of any hearing loss. These tests include:

  • The laboratory tests. If there is discharge from the ear, your doctor can order a laboratory test or culture to detect a bacterial infection of the middle ear.
  • Tuning fork evaluation.Tuning forks are two-pronged, metal instruments that produce sounds when struck. Simple tests with tuning forks can help your doctor to detect hearing loss. A range of assessment can also reveal whether hearing loss is caused by damage to the vibration of the parts of the middle ear (including the eardrum), damage to the sensors or the nerves of the inner ear, or damage to both.
  • Tympanometry. A tympanometer use a device that is inserted into the external auditory canal, which measures the response of the membrane of the eardrum to slight changes in air pressure. Certain patterns of response may indicate a perforation in the eardrum.
  • Audiology exam. This is a series of tests that measure how well you hear sounds at different volumes and tones. The tests are conducted in a soundproof booth.

Tuning fork evaluation. Tuning forks are two-pronged, metal instruments that produce sounds when struck. Simple tests with tuning forks can help your doctor to detect hearing loss.

A range of assessment can also reveal whether hearing loss is caused by damage to the vibration of the parts of the middle ear (including the eardrum), damage to the sensors or the nerves of the inner ear, or damage to both.

Treatment

The majority of ruptured (perforated) eardrums heal without treatment within a couple of weeks. Your healthcare provider may prescribe antibiotic drops if there is evidence of infection. If the tear or hole in the eardrum does not heal by itself, the treatment is likely to involve the procedures to close the tear or hole. These may include:

  • Eardrum patch.If the tear or hole in the eardrum does not close on its own, an OTOLARYNGOLOGIST may be sealed with a paper patch (or a patch made of another material). With this procedure in the office, your ENT doctor may apply a chemical to the edges of the tear, it can promote the ear drum healing, and then apply a patch over the hole. The procedure can be repeated more than once before the hole closes.
  • Surgery.If the patch does not result in adequate healing or your ENT doctor determines that the tear is not likely to be cured with a patch, he or she may recommend surgery. The most common surgical procedure called a tympanoplasty. Your surgeon grafts a patch of your own tissue to close the hole in the eardrum. This procedure is performed on an outpatient basis. In an outpatient procedure, you can usually go home the same day, unless anesthesia medical conditions require a longer hospital stay.

Eardrum patch. If the tear or hole in the eardrum does not close on its own, an OTOLARYNGOLOGIST may be sealed with a paper patch (or a patch made of another material).

With this procedure in the office, your ENT doctor may apply a chemical to the edges of the tear, it can promote the ear drum healing, and then apply a patch over the hole. The procedure can be repeated more than once before the hole closes.

Surgery. If the patch does not result in adequate healing or your ENT doctor determines that the tear is not likely to be cured with a patch, he or she may recommend surgery.

The most common surgical procedure called a tympanoplasty. Your surgeon grafts a patch of your own tissue to close the hole in the eardrum. This procedure is performed on an outpatient basis. In an outpatient procedure, you can usually go home the same day, unless anesthesia medical conditions require a longer hospital stay.

Self-care

A ruptured (perforated) eardrum usually heals spontaneously in a matter of weeks. In some cases, healing takes months. Until your doctor tells you that your ear is healed, protect it:

  • Keep the ear dry. Place a cap waterproof silicone or a cotton ball coated with vaseline on the ear when showering or bathing.
  • To refrain from cleaning of the ears. Give the eardrum time to heal completely.
  • Avoid blowing the nose. The pressure created when blowing your nose can damage the healing of the eardrum.

Preparing for your appointment

If you have signs or symptoms of a perforated eardrum, which is likely to start by seeing your provider. However, your doctor may refer you to a specialist in ear, nose and throat (ENT) disorders (ent).

Here's some information to help you prepare for your appointment.

What you can do

Make a list ahead of time, that you can share with your provider. Your list should include:

  • The symptoms that you're experiencing, including any that may seem unrelated to the hearing loss, the fluid discharge or other ear-related symptoms
  • Relevant events that may be related to their ear problems, such as a history of ear infections, the recent lesions in the ear or head trauma, or recent air travel
  • Medicines, including any vitamins or supplements you are taking
  • Questions for the provider

If you think you have signs or symptoms of a ruptured eardrum, you can ask your provider to some of the following questions.

  • I have a ruptured eardrum?
  • What else could be the cause of my hearing loss, and other symptoms?
  • If I have a ruptured eardrum, what can I do to protect my ear during the healing process?
  • What type of follow-up appointments will I need?
  • At what point should we consider other treatments?

Don't hesitate to ask other questions you have.

What to expect from your doctor

Your provider is likely to ask a series of questions, including:

  • When was the first experience of the symptoms?
  • Do you have symptoms such as pain or vertigo that clarify?
  • You have had ear infections?
  • Have you been exposed to loud sounds?
  • Has been swimming or diving recently?
  • Have you recently flown?
  • Have you been injured in the head?
  • Do you put anything in your ear to clean it?

What you can do in the meantime

If you think that you have a ruptured eardrum, be careful to keep the ears dry to prevent infection.

Do not go swimming until your condition has been evaluated and discussed with your doctor. To keep water out of the ear when the shower or bath, the use of a moldable, waterproof silicone stopper or place a cotton ball coated with vaseline on the outer part of the ear.

Do not put the medicine drops in the ear, unless your doctor has prescribed specifically for the infection-related perforation of the eardrum.

Symptoms and treatment of Rupture of the tympanic membrane (eardrum perforated)