Learn more about eardrum perforation and what causes it.
A hole or tear in the tympanic membrane (eardrum) is referred to as an eardrum perforation. Involving the tissue that separates the middle ear and the ear canal, a ruptured eardrum may occur suddenly and produce sharp pain or persistent discomfort.
In some instances, previous earaches will suddenly go away when an eardrum ruptures, and other individuals will have no symptoms at all
While some eardrum perforations will heal on their own within a few weeks, there are times when medical attention is necessary to repair the hole and restore normal functioning
Eardrum ruptures often result from a sudden change in pressure, as is possible when a scuba diver is coming to the surface or when riding within a pressurized airplane cabin. Air pressure changes are referred to as barotrauma, or an imbalance in air pressure within an individual’s surroundings. Accidents or a sudden forceful blow to the ear from something like an airbag discharging during a vehicle collision may also result in an eardrum perforation. Pressure on the eardrum is sometimes caused by the buildup of accumulated fluids in the middle ear from a middle ear infection (otitis media). Some other possible causes of eardrum perforations include:
Acoustic trauma (sudden exposure to loud noises or sounds)
Foreign objects (e.g., small items like a hairpin, pencil, or cotton swab) in an ear
Severe injury or trauma to the head
A direct blow to the ear or a hard slap against the ear
Signs and Symptoms
Some people experience a general discomfort that won’t go away, and other individuals will have no symptoms at all when an eardrum ruptures. It’s also possible to hear air coming out of the ear while blowing your nose if there’s a hole in an eardrum. It’s sometimes possible for others to hear this sound, as well. Additional signs and symptoms that may be associated with eardrum perforations include:
Clear fluid, pus, or blood coming from the affected ear
Some degree of hearing loss
Ear buzzing or noise
Dizziness or a spinning sensation (vertigo)
Nausea related to vertigo
Ear pain suddenly going away
In addition to producing sound vibrations, the eardrum also provides protection for the middle ear by keeping out bacteria, foreign objects, and moisture. When the eardrum becomes torn, however, an infection can develop in the middle ear. Hearing loss is often a temporary complication, usually going away after the hole heals on its own or is repaired surgically. A ruptured eardrum sometimes contributes to the formation of a middle ear cyst (cholesteatoma).
Diagnosis of Eardrum Ruptures
When there’s discharge from the affected ear, laboratory tests may be done to identify if there’s a bacterial infection in the middle ear. Diagnosis of damage to an eardrum may also involve a tuning fork evaluation to detect hearing loss. This test may also determine a possible source of the hearing loss. The eardrum is sometimes further evaluated with tympanometry, a procedure involving the use of a device called a tympanometer that’s inserted into the ear canal to detect changes in air pressure. Some patients benefit from a full audiological exam if a ruptured eardrum cannot be conclusively diagnosed from other tests. This type of testing is more detailed and will likely identify an eardrum perforation.
Treating Eardrum Perforations
Antibiotic drops may be prescribed to treat infections related to eardrum perforation, otherwise most ruptures will heal without significant intervention. If a hole or tear in an eardrum isn’t healing after a few weeks, treatment recommendations may include:
An eardrum patch: During this in-office procedure, a chemical is applied to outer area of the tear to stimulate tissue growth. A patch is then placed over the hole. Multiple treatments may be necessary.
Surgery: If patch treatments aren’t effective, surgery may be recommended. A tympanoplasty is the most common procedure performed. The outpatient procedure involves the use of a patient’s own tissue to close the eardrum hole.
Ear perforation is often preventable when keeping the right precautions in mind. Middle ear infections that aren’t going away shouldn’t be ignored. Treating such infections early can minimize the risk of related issues with sensitive eardrum tissues. Care should be taken with the use of cotton swabs. They shouldn’t be inserted into the ear canal. Proper ear protection during airplane trips and when exposed to loud noises, especially anything consistent like work-related noise, can also protect eardrums and reduce the odds of experiencing a ruptured eardrum.