Known medically as tympanic membrane perforation, a ruptured (or perforated) eardrum occurs when a hole or tear forms in the thin tissue that separates your ear canal from your middle ear (your eardrum). A ruptured eardrum can lead to hearing loss and can also make the eardrum vulnerable to additional injury or infections. Some cases heal relatively quickly on their own, while others may require a procedure or surgical repair.

Symptoms and Complications

Signs and symptoms of a ruptured eardrum can include:

• Ear pain that might go away quickly
• Drainage from the ear—clear, pus-filled or bloody
• Hearing loss
• Ringing in the ears (tinnitus)
• Spinning sensation (vertigo), and resulting nausea or vomiting

If you experience any of these symptoms, call your doctor. The ears are a very sensitive area prone to injury or disease, and speedy treatment is important for preserving hearing.

The eardrum is in charge of both managing hearing and protecting the middle ear from water, bacteria and other threats. Complications from ruptured eardrums can occur during healing, or due to a failure to heal. These complications might include:

• Hearing loss: Usually temporary and lasting only until the tear or hole in the eardrum has healed.
• Middle ear infection (otitis media): When a perforated eardrum allows bacteria into the ear. This may lead to chronic infections that cause permanent hearing loss if a perforated eardrum isn’t repaired.
• Middle ear cyst (cholesteatoma): A cyst in the middle ear made up of skin cells and other debris. Often formed by ear canal debris passing into the middle ear and allowing the buildup of bacteria, along with proteins that can damage bones in the middle ear.

Causes

Causes of a ruptured or perforated eardrum can include:

• Middle ear infection: Accumulation of fluids in the ear can cause the rupturing of the eardrum.
• Barotrauma: Barotrauma, or stress on the eardrum due to imbalances in the air pressure in the ear versus air pressure in the environment, can cause an eardrum to rupture. Barotrauma is commonly caused by air travel, scuba diving or direct blows to the ear.
• Acoustic trauma: Loud sounds or blasts, like those heard in an explosion or gunshot, can cause a tear in the eardrum.
• Foreign objects in the ear: Small objects like cotton swabs or hairpins can puncture or tear the eardrum.
• Severe head trauma: Severe injury like skull fractures can dislocate or damage the middle and inner ear structures, the eardrum among them.  

Diagnosis and Treatment

In many cases, diagnosing a perforated eardrum is as simple as a visual exam using an otoscope (lighted instrument). Additional tests may be ordered to determine the cause of the rupture or the degree of the damage, including:

• Lab tests: If discharge is present from the ear, your doctor may order a test to detect a bacterial infection.
• Tuning fork evaluation: Tuning forks are two-pronged instruments that produce sounds when hit, and can be used to detect hearing loss or to reveal what hearing loss is caused by—damage to vibrating parts of the ear (including eardrum), damage to sensors or nerves in the inner ear, or both.
• Tympanometry: A device inserted into the ear that measures the eardrum’s response to slight changes in air pressure, and can indicate a perforated eardrum.
• Audiology exam: If other tests come back inconclusive, your doctor may order this series of strictly calibrated tests, which take place in a soundproof booth and measure how you hear sounds at various volumes and pitches.

In most cases, perforated eardrums will heal on their own without treatment after a few weeks. If infection is present, you may be prescribed antibiotic drops. If the tear or hole does not heal on its own, treatment procedures to close it may include:

• Eardrum patch: Applied by an ENT specialist, this is a patch that’s often accompanied by a chemical on the edges of the tear to stimulate growth. This may need to be done more than once.
• Surgery: If a patch doesn’t work or it’s determined that a patch isn’t likely to heal the tear, surgery may be recommended. The most common surgery is called tympanoplasty, which involves closing the hole in the eardrum with a graft of your own tissue. This is an outpatient procedure unless anesthesia requires a longer hospital stay.

Prevention Techniques

There are a few things you can do to avoid a ruptured or perforated eardrum:

• Get treatment for ear infections to avoid damage to the eardrum.
• Protect ears during flight, and try not to fly with a cold or active allergies that lead to congestion.
• Keep your ears free of foreign objects, and don’t attempt to dig out excess ear wax with cotton swabs, paper clips or hairpins, which can tear or puncture the eardrum.
• Guard against excessive noise using earplugs or earmuffs if loud noise is present.

If you or your child has a ruptured eardrum, speak to your doctor right away about diagnosis and treatment options.

Our specialists have received extensive training and completed a variety of procedures, offering the best ENT care for our patients. Our team also has access to a variety of specialties to ensure that patients receive coordinated care.

Sources:

“Ruptured eardrum (perforated eardrum).” The Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/ruptured-eardrum/home/ovc-20265959

“Ruptured Eardrum: Symptoms and Treatments.” WebMD. http://www.webmd.com/pain-management/ruptured-eardrum-symptoms-and-treatments#1