Perforated Eardrum (Ruputured Eardrum)

Picture of the inner and outer structures of the ear

• The eardrum (tympanic membrane) is a thin, oval layer of tissue deep in the ear canal that helps protect the delicate middle and inner ear from the outside. Because it is so thin, the eardrum can be ruptured or perforated, exposing the ear to damage or infection.
• The main causes of ruptured eardrum are ear infection of the middle ear (otitis media) or trauma to the ear or head.
• Symptoms and signs of perforated eardrum include
  • ear pain,
  • vertigo or dizziness,
  • hearing changes or hearing loss,
  • ringing in your ears (tinnitus), or
  • fluid or blood draining from the ear.
• Seek medical care for a perforated eardrum if you have difficulty walking, changes in hearing, severe spinning sensation, or your head goes under water. Seek emergency medical treatment if you have a stiff neck, high fever, "the worst headache of your life," numbness or tingling, difficulty speaking, vomiting, vision changes, or difficulty staying awake.
• A health care professional can tell if you have a ruptured eardrum by using an otoscope, which is an instrument that has a magnifier with a light, designed to look inside the ear. Other tests may include a tympanogram (a burst of air against the eardrum), or an audiogram (hearing test).
• Most of the time, a perforated eardrum will heal on its own within two months.
• If treatment is necessary, it may include pain relievers and antibiotics. In some cases, surgery is required to repair the rupture.
• Not all cases of perforated eardrum can be prevented, but you can lower your risk by treating ear infections, avoiding flying or scuba diving if you have a sinus or upper respiratory tract infection, not putting anything in your ear, and wearing proper ear protection when needed.
• Most ruptured eardrums will heal on their own within two months with no long-term symptoms. In rare cases, infection can spread to the brain or skull, requiring immediate medical attention.

A perforated (ruptured) eardrum is a hole or tear in the eardrum.

• The eardrum (tympanic membrane) is a thin, oval layer of tissue deep in the ear canal.
• It is called an eardrum because it looks and acts like a drum.
• The eardrum helps protect the delicate middle and inner ear from the outside, and it receives vibrations from the outer ear and transmits them to the small hearing bones (ossicles), of the middle ear.
• Because the eardrum is so thin, it can be ruptured or punctured. The hole or tear exposes the middle and inner ear to damage or infection.
• An eardrum rupture is also called a tympanic membrane perforation.

Middle ear infection is the most common cause of a ruptured eardrum.

• Ear infections can be caused by viruses, bacteria, or fungi.
• Middle ear infections increase the pressure behind your eardrum, stretching the drum and causing pain.
• When the eardrum can no longer stretch, it bursts or tears.
• Frequently, the earache gets better, because the pressure is now relieved, however, sometimes the pain can get worse.

Trauma can also cause perforation.

• Blunt or penetrating trauma, such as from a fall on the side of your head or a stick that goes deep in your ear
• Rapid pressure changes, for example, scuba diving (barotrauma, ear pain, or ear squeeze)
• Slaps to the ear, such as a fall while water skiing or a hand slap to the side of the head
• Lightning blasts
• Blast waves from gunshots, fireworks, and other loud noises or explosions
• Changes in air pressure during air travel or scuba diving
• Sharp objects or cotton swabs
• Motor vehicle accidents
• Falls
• Sports injuries

Earache is the most common symptom of a perforated eardrum. The pain can include:

• General discomfort
• Immediate, sharp, or intense pain
• Pain that suddenly gets better
• A feeling as if something is not right with the ear

Other common symptoms and signs of perforated eardrum include:

• Vertigo (spinning sensation)
• Dizziness
• Hearing changes
  • Often with ringing (tinnitus), buzzing, clicking, or other noise
• Hearing loss
• Fluid (may be clear or pus-colored) or blood draining from the ear

Call a doctor immediately if you suspect you or someone you know has a ruptured eardrum and any of the following occur:

• An uncontrolled spinning sensation
• Difficulty walking
• An abrupt change in hearing
• A change in the ability to taste foods
• You accidentally put your ear under water

The following symptoms suggest a potentially life-threatening complication and require immediate medical evaluation:

• Stiff neck
• High fever
• The worst headache of your life
• Numbness or weakness in face, arms, or legs
• Difficulty talking or opening mouth
• Continued vomiting
• Pain or swelling behind the ear
• Abrupt change in vision
• Difficulty staying awake

The doctor can diagnose eardrum rupture by taking a history and looking in the patient's ear with an otoscope -- a special magnifier with a light.

• Occasionally, very small holes can be difficult to identify and may require further testing.
• Tympanogram is a test that uses a short burst of air against the eardrum
• Audiogram is a hearing test

• Because most perforated eardrum injuries heal on their own within two months, treatment may include analgesics to alleviate pain and antibiotic eardrops to prevent infection of the middle ear.
• The doctor will likely advise the patient to keep the ear clean and dry while healing. This means swimming and scuba diving are not advised until a doctor says it is safe to do so.

If the perforation is due to a foreign object in the ear, do not try to remove it yourself. Only a medical professional should attempt to remove any foreign bodies in the ear.

Some large perforations or non-healing small holes require surgery.

Surgical procedures are performed with a general anesthetic. Most people go home from the hospital or clinic on the same day.

• An ear, nose, and throat specialist (ENT, otolaryngologist) may graft or patch the eardrum with paper, fat, muscle, or other material.
• These materials act as a bridge, allowing the tympanic membrane to grow together.

Which specialties of doctors treat a perforated (ruptured) eardrum?

A primary care provider (PCP) such as a family practitioner, an internist, or child’s pediatrician may diagnose the rupture of an eardrum. You may also see an emergency medicine specialist in a hospital’s emergency department.

Most perforated eardrums heal on their own, but if you need further treatment such as a paper patch or surgery, you may see an otolaryngologist (ear, nose, and throat specialist, or ENT).

After a few weeks, the patient should notice no long-term symptoms. Eardrum perforations generally heal within two months, and any accompanying hearing loss is usually temporary. Rarely, a dangerous infection can spread into the brain or skull. This requires immediate hospitalization or surgery. Also, if the patient has symptoms of severe dizziness and vomiting, facial paralysis, or hearing loss, more extensive surgery of the inner or middle ear may be required beyond patching the eardrum.

Some causes of ruptured eardrums cannot be prevented or avoided. A little caution can lower the risk.

• Treat an ear infection (otitis media) early.
• Avoid flying or scuba diving if you have sinus infection or upper respiratory tract infection.
• If you must fly or scuba dive, pinch your nose and swallow air frequently to help with pressure-equalizing.
• Never put anything in your ear, even to clean it (for example, cotton-tipped Q-Tips).
• Wear proper ear protection such as earplugs or protection designed for sports activities and to provide protection from loud noises.