Eardrum Perforation

A perforated eardrum can result from infection, injury, pressure changes, or direct trauma.

Ear Infections

A middle ear infection, or otitis media, can cause fluid and pressure to build behind the eardrum. In some cases, the pressure can cause the eardrum to rupture. A perforation caused by an ear infection may result in drainage from the ear and can sometimes reduce the pressure and pain associated with the infection.

Ear Trauma

Objects inserted into the ear can injure or puncture the eardrum. Common examples include:

• Cotton swabs
• Hairpins or other small objects
• Accidental impact to the ear
• Ear-cleaning instruments

Avoid putting objects into the ear canal, particularly if you suspect an eardrum injury.

Changes in Air Pressure

Rapid changes in pressure can injure the eardrum. This is called barotrauma. Potential causes include:

• Air travel
• Scuba diving
• Rapid pressure changes during diving
• Significant pressure or trauma to the ear

Barotrauma can occur when pressure inside and outside the middle ear cannot equalize effectively.

Loud Noise or Acoustic Trauma

Extremely loud sounds or blasts can damage the eardrum and other structures involved in hearing. Acoustic trauma may also injure the inner ear, so hearing should be evaluated after significant noise exposure.

Head Trauma

Significant head injuries can damage the eardrum and other structures of the middle or inner ear.

Symptoms vary depending on the cause and severity of the perforation. Common symptoms include:

• Hearing loss
• Ear pain
• Fluid or pus draining from the ear
• Bloody ear drainage
• Tinnitus or ringing in the ear
• A feeling of pressure or fullness
• Dizziness or vertigo
• Sudden improvement in pain followed by ear drainage

A perforated eardrum may sometimes cause relatively few symptoms, particularly when the perforation is small. If hearing suddenly decreases, particularly after an injury, loud-noise exposure, or pressure change, prompt medical evaluation is important because the hearing loss may involve structures beyond the eardrum.

Yes. A perforated eardrum can cause hearing loss. The eardrum plays an important role in transmitting sound to the middle-ear ossicles. A hole or tear can interfere with this process and result in conductive hearing loss. The amount of hearing loss depends on factors such as:

• The size of the perforation
• The location of the perforation
• Whether the middle-ear bones are intact
• Whether an infection or fluid is present
• Whether the inner ear has also been affected

Hearing often improves when the eardrum heals, but persistent perforations can continue to affect hearing.

Diagnosis begins with a detailed history and examination of the ear.

Otoscopic Examination

An ENT specialist can often identify a perforation by examining the eardrum with an otoscope or specialized microscopic equipment. The examination can help determine:

• Whether a perforation is present
• Its size and location
• Whether drainage or infection is present
• Whether the middle ear appears abnormal
• Whether there are signs of chronic ear disease

Hearing Test

A comprehensive hearing test or audiogram can determine whether the perforation has caused hearing loss and identify the type and degree of hearing impairment.

Tympanometry

Tympanometry evaluates how the eardrum and middle-ear system respond to changes in air pressure. It can provide additional information about the condition of the eardrum and middle ear. Additional testing or imaging may be considered when the examination suggests damage to the middle-ear bones, chronic ear disease, cholesteatoma, or another underlying conditi

Many perforated eardrums heal without surgery. Small perforations may close naturally over several weeks. Some take longer to heal, depending on the cause and condition of the ear.

During the healing period, protecting the ear from additional injury and keeping water out of the ear may be recommended. Your physician can tell you when swimming and other activities are safe. A perforation that does not close, repeatedly becomes infected, or causes persistent hearing problems may require additional treatment.

Treatment depends on whether the perforation is new or chronic and whether infection, hearing loss, or damage to other middle-ear structures is present.

Observation

If the perforation is expected to heal naturally and there are no complications, a physician may recommend observation and follow-up.

Treating an Ear Infection

If infection is present, treatment may include medication prescribed specifically for the condition. Not every perforated eardrum requires antibiotics. Treatment should be based on the presence and type of infection and the physician’s examination.

Keeping the Ear Dry

Keeping water out of the affected ear can help reduce the risk of infection while the eardrum is healing. Do not put ear drops into an ear with a suspected perforation unless they have been specifically recommended or prescribed by a healthcare professional.

Eardrum Patch

For selected persistent perforations, an ENT specialist may use a patch procedure to encourage the edges of the perforation to close. A patch may be performed in the office and, in some cases, may need to be repeated.

Tympanoplasty

When a perforation does not heal or requires surgical repair, the procedure commonly used is called tympanoplasty. Tympanoplasty is surgery to repair a perforated eardrum. During tympanoplasty, the surgeon uses tissue to close the opening in the eardrum. Depending on the condition of the ear, the procedure may also address problems involving the middle-ear structures. Tympanoplasty may be considered when:

• The perforation persists
• The ear repeatedly becomes infected or drains
• Hearing loss continues
• The perforation is unlikely to close on its own
• There is associated middle-ear disease

The decision to perform surgery should be based on the individual patient’s examination and hearing evaluation.

Tympanoplasty is designed to close the perforation and restore the protective barrier of the eardrum. The specific surgical approach depends on the location and size of the perforation and whether other structures of the middle ear are involved.

In some patients, repair of the eardrum may be the only procedure necessary. In others, additional reconstruction of the middle-ear bones may be appropriate if the ossicles have been damaged. A hearing test before and after treatment can help determine how the condition and treatment have affected hearing.

A persistent perforation can leave the middle ear more vulnerable to water and bacteria entering through the ear canal. Potential problems include:

• Recurrent middle-ear infections
• Persistent ear drainage
• Conductive hearing loss
• Chronic middle-ear disease
• Damage to middle-ear structures
• Cholesteatoma in uncommon cases

Most complications are not common, but persistent perforation warrants appropriate follow-up. A cholesteatoma is an abnormal collection of skin cells and other material in the middle ear that can damage surrounding structures if it progresses.

Generally, you should keep a perforated eardrum dry unless your physician tells you otherwise. Water entering the middle ear through a perforation can increase the risk of infection. Your physician can recommend appropriate protection for bathing and determine when swimming is safe.

Whether flying is appropriate depends on the cause and current condition of the ear. If the perforation resulted from recent barotrauma, infection, surgery, or another ear condition, discuss air travel with your physician before flying. Pressure changes during air travel can affect the middle ear, particularly when the Eustachian tube cannot equalize pressure normally.

Until the ear has been evaluated and your physician confirms that it is safe, avoid:

• Putting cotton swabs or other objects into the ear
• Swimming without appropriate medical guidance
• Getting water into the affected ear
• Using non-prescribed ear drops
• Attempting to clean the middle or inner portion of the ear yourself
• Exposing the ear to additional trauma or very loud noise

If you have a known perforation, follow the specific precautions provided by your ENT specialist.

Consider an ENT evaluation if you have:

• Persistent hearing loss
• Ear drainage
• Recurrent ear infections
• A known perforated eardrum
• Ear pain after an injury
• Hearing changes after flying or diving
• Tinnitus or dizziness following an ear injury
• A perforation that has not healed
• Repeated problems with the same ear

Sudden hearing loss should not automatically be attributed to a perforated eardrum. Sudden sensorineural hearing loss is a different condition that requires prompt evaluation.

Until the ear has been evaluated and your physician confirms that it is safe, avoid:

• Putting cotton swabs or other objects into the ear
• Swimming without appropriate medical guidance
• Getting water into the affected ear
• Using non-prescribed ear drops
• Attempting to clean the middle or inner portion of the ear yourself
• Exposing the ear to additional trauma or very loud noise

If you have a known perforation, follow the specific precautions provided by your ENT specialist.