What is a Perforated Eardrum?

A perforated eardrum is when a hole forms in the thin membrane that sits in the middle of the ear canal. This thin membrane is the eardrum, also known as the tympanic membrane. The tympanic membrane helps protect your ear from infections and vibrates to help you hear sounds. When the eardrum tears and drains, fluid leaks into the middle ear. This can lead to hearing loss or severe pain in your ear. 

It is possible for this condition to worsen if not treated quickly. Left untreated, hearing loss can occur. It can be a temporary condition, or it can be permanent. A perforated eardrum is also called a ruptured eardrum, burst eardrum, or a hole in the eardrum.

Symptoms

Ruptured eardrum symptoms often come on suddenly. The perforated eardrum symptoms can be temporary or permanent.

Signs of a perforated eardrum:

• Pain 
• Swollen eardrum
• Loss of hearing
• Ringing sound
• Nausea
• Dizziness
• Vomiting
• Discharge from ear
• Feeling like you are spinning

Causes

There are three main ruptured eardrum causes: infection, pressure changes, and injury/trauma. The most common cause of a perforated eardrum is an infection due to bacteria.

Infection

An infection can lead to excess fluid collecting behind the eardrum, which puts pressure on the eardrum. Sometimes, this pressure intensifies and breaks the eardrum.

Pressure Changes

When you experience major shifts in pressure, it can cause a rupture in your eardrum. This is called barotrauma.

Activities that can cause major pressure changes in the ear: 

• Air travel
• Scuba diving
• A direct and intense blow to the ear
• High-altitude driving
• Skydiving

Injury/Trauma

Any injury or trauma to your eardrum might also cause a rupture. You can sustain trauma to your eardrum in many ways.

Possible injuries that might cause a perforated eardrum:

• Loud explosions
• Falling
• Vehicle accidents
• A punch, kick, or strike to your ear
• Sports injuries

Diagnosis

Your doctor might use a variety of tests to diagnose a punctured eardrum. In many cases, your doctor will make an initial diagnosis based on a visual inspection of your ear using a specialized medical tool called an otoscope. Your doctor may perform additional tests to corroborate this initial diagnosis.

Diagnostic tests:

• Otoscope exam — An otoscope exam is the most common and basic form of ear exam for the identification of an eardrum rupture. An otoscope is a handheld lighted magnifying tool that provides an adequate view of the eardrum to identify a rupture. This exam is usually performed by an ear, nose, and throat — or ENT— physician.
• Fluid sample — If there is discharge from your ear, your doctor may test the fluid for signs of a bacterial infection.
• Audiology exam — This exam involves a series of tests that measure your sensitivity to sounds.
• Tympanometry — This test uses a device called a tympanometer to measure how your eardrum reacts to changes in pressure. Your doctor inserts the device into your ear canal and then directs a puff of air into your ear. The tympanometer then measures how your eardrum responds to the pressure change. 

Treatment

Ruptured eardrums typically heal on their own within a few weeks, but in some cases may require additional treatment. The three main types of ruptured eardrum treatment are patching, surgery, and medication.

Patching

Patching is when your doctor covers the tear in your eardrum with a medicated paper patch. The patch helps keep water and other fluid out of the hole in your eardrum. The patch also helps the rupture to heal and close.

Surgery

Surgery is rarely needed to treat a ruptured eardrum. If surgery is needed, your doctor might perform a procedure called a tympanoplasty. During this procedure, your doctor will use tissue from another part of your body to patch the tear.

Medication

Your doctor might prescribe antibiotics to clear up an existing infection and to prevent future infections. You might receive oral antibiotics or medicated ear drops. Sometimes, your doctor will prescribe both forms of medication.

Complications

If the tear in your eardrum does not heal properly, you might experience complications. Some of these complications can be serious and permanent.

Possible burst eardrum complications:

• Hearing loss — You might experience hearing loss until your burst eardrum is fully healed. Most of the time, hearing loss is a temporary complication. However, specific factors such as location and size of the rupture impact the severity of the effects.
• Middle Ear cyst — A rare complication is when a cyst develops in your middle ear. A cyst can nurture the growth of bacteria and infection. A cyst can also possess proteins that can harm bones in your ear.
• Middle Ear infection — Bacteria can enter the ear, causing regular infections. Ongoing or chronic infections can result in long-term hearing loss or fluid drainage.

Prevention

You can take steps to help prevent ear damage.

Tips for ear damage prevention:

• Treat ear infections immediately — The sooner you seek and get treatment for ear infections, the more you can prevent damage to your ear. Knowing the signs and symptoms of burst eardrums is important to prevention.
• Valsalva maneuver during airplane flights — The Valsalva maneuver is when you close your mouth, pinch your nose shut, and try to exhale. This maneuver helps equalize pressure in your ears when the cabin pressure changes.
• Avoid sticking objects into the ear — Inserting your finger, a pencil, a cotton swab, or any other foreign object into your ear can unintentionally cause damage.
• Use earplugs if exposed to repeated loud noise — Avoid exposing your eardrums to loud, explosive sounds. Activities such as listening to loud music, firing guns while hunting, and construction work can all injure your eardrum. If you do engage in activities that involve explosive sounds, wear ear protection such as earplugs.