Perforated Eardrum

What is a Perforated Eardrum?

A perforated eardrum is just as it sounds – it is a tear or a hole in your eardrum (tympanic membrane). According to government data, as many as 150,000 tympanoplasties are performed each year in the United States. Your eardrum is the thin tissue that separates your middle ear from your ear canal. It is important to understand that behind the eardrum, there are several physical features that not only support hearing, but also support balance. Many people are unaware that they have a cold until they blow their nose. Many also don’t realize that each ear is connected to the nose through the Eustachian tube, which plays an important role of equalizing pressure in the middle air.

Our ears are also the key organ that controls our sense of balance. This essential capability is hidden in tiny, semi-circular canals in our inner ear that are called the vestibular system. These small canals provide our brain with information, such as our angular and linear acceleration, that allow us to navigate the world without falling flat on our faces.

How does all the hearing and orientation data get to the brain? Located in the inner ear is a sophisticated nerve network, which collects and transmits hearing (cochlear nerve) and balance (vestibular nerve) data. This data is transferred via the vestibulocochlear nerve to the brain.  It is important that eardrum perforations are treated professionally, since the inner ear shelters such essential capabilities. It is also important to prevent the migration of germs from the ear canal into the inner ear, where an infection can develop.

What are the symptoms of an Eardrum Perforation?

  • Pain in the ear that may pass quickly
  • Loss of hearing
  • Fluid, pus or bloody liquid draining from ear
  • Persistent ringing in the ear (tinnitus)
  • Dizziness, loss of balance (vertigo)
  • Nausea resulting from dizziness
  • Slight whistling heard when blowing the nose or sneezing

What can cause a Perforated Eardrum?

A perforated eardrum can be caused by athletic traumas from wrestling, boxing, soccer, football or water skiing, especially if the ear is hit directly or a skull is fractured. Scuba diving can also cause eardrum perforations due to sudden pressure changes, especially when ascending.

Pressure differentials (barotrauma) can cause eardrum perforations, especially for laborers in deep mines and tunnels, bridge builders working in pressurized caissons and aviation workers.

Sudden explosions (acoustic trauma) from fireworks or a bomb will cause perforated eardrums.

Simple carelessness, such as sticking a Q-tip or a hairpin in the ear, or by removing ear wax incorrectly can cause perforated eardrums.

Infections are the principal cause of eardrum perforations. When an infection occurs in your inner ear, it can create enough mucous and pus  to build up sufficient pressure in the inner ear, which can burst the eardrum or cause it to tear. (To learn more about mid-ear infections, click on the link in the top menu under ENT.)

In some cases, a patient who has had a pressure equalizing (PE) tube removed may have a slight tear, but most small tears will heal themselves quickly.

What can happen if my child’s perforated eardrum is not treated by a doctor?

  • Hearing loss
  • Persistent ear infections (otitis media)
  • Middle ear cyst (cholesteatoma)
  • Meningitis
  • Mastoiditis (a rare bone condition)

How are eardrum perforations evaluated by your doctor?

If your doctor suspects that you or your child has a perforated eardrum, he or she will ask you several questions relating to what you were doing before you developed your symptoms. They will also physically examine you using an instrument called an otoscope to examine your ear canal and eardrum. They will be looking for signs of tears, inflammation, swelling and redness on or near the eardrum. A healthy eardrum is usually pinkish gray and transparent.

Your doctor may take a culture to test for an inner ear infection, if there are signs of mucous or pus-like discharges from the ear. Some doctors may perform a tuning fork evaluation to detect hearing loss and the cause of the hearing loss; some may suggest a full audiology exam. Your doctor may use tympanometry, which will measure how your eardrum responds to slight changes in pressure.

How do you treat a perforated eardrum?

Watchful Waiting

While it may be upsetting to hear that you have a ruptured or perforated eardrum, many eardrums heal themselves within a few weeks without any treatment, just watchful waiting. However, your doctor may prescribe antibiotics if an infection is suspected. It is wise to refrain from blowing your nose with force during this healing period.

Eardrum Patch (Myringoplasty)

If the eardrum does not heal, your doctor may suggest an eardrum patch, which is a simple, in-office procedure. During this process, your ENT professional will apply a chemical to the edges of the tear that will stimulate growth. He or she will then apply a patch over the hole or tear. This process may be repeated in a week or two until the eardrum is sealed.

Tympanoplasty

There are times when the eardrum patch procedure is not successful, or your doctor may feel that the eardrum is too badly damaged to be patched.  In these cases, your doctor may recommend a tympanoplasty.  This is a frequently performed procedure that grafts a small patch of your own tissue to seal the hole in your eardrum. It’s usually performed in a surgical center or a hospital, and the patient is placed under anesthesia. Your ENT surgeon will use your ear canal to gain access to your eardrum, or make a small incision behind your ear to gain more direct access to the eardrum. He or she will use a laser to remove any tissue that is in the way of the graft. Since the tympanoplasty is typically performed on an outpatient basis, the individual will usually be able to go home the same day.