Eardrum Perforation

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 usually occurs suddenly and produces a sharp pain.

• In some instances, previous earaches will suddenly go away when an eardrum ruptures
• 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 most often occur as a result of infections behind the ear drum (middle ear). Other causes include abnormal eustachian tube function during a sudden change in pressure, as is possible when a scuba diver is descending or when an airplane is landing. Air pressure changes are referred to as barotrauma, or an imbalance in air pressure within an individual’s surroundings. Some other possible causes of eardrum perforations include:

• Acoustic trauma (sudden exposure to very loud sounds such as explosions)
• Foreign objects (e.g., small items like a hairpin, pencil, or cotton swab) in an ear
• Severe injury or trauma to the head which causes a fracture of the temporal bone
• A direct blow to the ear or a hard slap against the ear

The time at which the perforation of the ear drum occurs is very painfu, though not everyone will remember the time as it may have occurred in childhood. Some people can 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) (uncommon)
• 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).

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 involves examination of the ear that is done with a microscope or an otoscope. It may also involve a tuning fork evaluation to detect 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 movement of the ear drum with changes in air pressure. Nearly all patients with a tympanic membrane perforation will benefit from a full audiological exam.

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.
• The ear drum patch can be performed with paper and serum (a component of blood which contains growth factors which can improve healing. Some blood is removed from the arm and sent to lab for processing. The patient uses the serum drops for a few weeks.
• Occasionally, we may perform the ear drum patch procedure with the patient’s own tissue under local anesthesia in the office.
• Surgery: If patch treatments aren’t effective, surgery may be recommended. A tympanoplasty with possible mastoidectomy is the most common procedure performed. The outpatient procedure involves the use of a patient’s own tissue to close the eardrum hole and removal of infection from the middle ear and mastoid.

Ear perforation is not always preventable even 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 or any other foreign body in the ear canal. They shouldn’t be inserted into the ear canal.