Ruptured Eardrum (Perforated Tympanic Membrane)

What is a ruptured eardrum?

A ruptured or perforated eardrum is an eardrum that has a tear or hole in it. The eardrum is a thin membrane inside the ear canal. It separates the outer ear from the delicate structures of the middle and inner ear. Besides protecting the inner and middle ear from cold, wind, earwax, and anything else that might find its way into your ear, the eardrum helps you hear. It receives vibrating sound waves and transmits them to the tiny bones in your ear.

A tear or hole in the eardrum exposes the middle ear and inner ear organs to potential damage or injury. The hole may cause some hearing loss.

How does it occur?

The most common cause of a ruptured eardrum is a middle ear infection (otitis media). When the infection causes a buildup of pus or fluid in the middle ear, pressure increases in your ear and is painful. This buildup of fluid can cause the eardrum to burst (rupture).

Injury and sudden pressure changes are also common causes of a ruptured eardrum. A tear can happen if you try to clean your ear with a cotton-tipped swab or other object. An injury to the side of the head or a blow to the ear can also cause the eardrum to rupture. Possible causes of severe pressure or suction to the ear are sudden altitude or air pressure changes while flying in an airplane, swimming or diving accidents, or a nearby explosion.

What are the symptoms?

Often there are no symptoms. When the rupture is caused by a middle ear infection, you may feel a sudden sharp pain. However, in the case of an ear infection, you may actually feel a sudden decrease in pain as the built-up fluid drains out. You may see some discharge from the ear that looks like pus.

When the rupture is caused by an injury, your only symptom may be general discomfort from the injury itself. You may have some bleeding from your ear.

For a few days after the rupture you may have:

• some discomfort in your ear (especially in cold or windy weather)
• a sense that something is just not right in your ear
• some hearing loss.

How is it diagnosed?

Usually your healthcare provider can see the tear by looking into your ear canal using an otoscope (a light for looking in ears). Sometimes a rubber bulb attached to the otoscope is used to blow a puff of air into the ear to try to make the eardrum move. A normal eardrum moves when the air reaches it; an eardrum with a hole in it does not move.

How is it treated?

A small hole in the eardrum often heals itself, sometimes within a couple of weeks. During this time your ear needs to be protected from water (for example, in the bath, shower, or pool). Your ear will feel better if you protect it also from cold air.

Your healthcare provider may prescribe antibiotic eardrops to help protect your ear from infection while the eardrum is healing. You may need to take oral antibiotics also. Because your eardrum cannot protect the inner ear as it normally does, do not use any ear medicines except medicines prescribed by your provider for this specific ear problem.

Your healthcare provider will want to see you again in a couple weeks. If the hole is large or your eardrum is not healing, you may need surgery to repair it. Your surgeon can use some of your own tissue as a patch to close the hole. Depending on the size and location of the hole, the repair is done through the ear canal or through a cut behind the ear. The operation is often done with a general anesthetic. It is usually a simple procedure and does not require staying overnight in the hospital.

How long do the effects last?

A small rupture in your eardrum usually heals within a few weeks. Hearing usually returns to normal after the eardrum has healed. If a ruptured eardrum does not heal and is not surgically repaired, you may have permanent hearing loss.

How do I take care of myself?

• Follow all the instructions from your healthcare provider.
• Keep the ear dry. Ask your healthcare provider how to keep your ear dry when you bathe or shower.
• Do not use any ear medicines except those prescribed by your healthcare provider.
• For pain take a nonprescription pain reliever such as acetaminophen or ibuprofen.
• Avoid swimming until your provider tells you your ear is healed and it is OK to swim.
• Avoid blowing your nose hard while your ear is healing.

How can I help prevent a ruptured eardrum?

If you have symptoms of an ear infection, such as an earache or feeling of blockage in the ear, see your healthcare provider promptly.