A perforated eardrum is a tear or hole in the thin membrane that separates the outer and middle ear. This can cause discomfort and hearing changes and is often a result of pressure changes, injury, or infection.
- Causes: The most common causes are middle ear infections, barotrauma (due to rapid pressure changes from flying or diving), physical injury from objects like cotton buds, or exposure to sudden loud noises.
- Symptoms include sudden, sharp ear pain that may subside, muffled hearing or hearing loss, fluid drainage (clear, bloody, or pus-filled), and a feeling of fullness in the ear.
- Diagnosis is made by a healthcare professional through an examination of the ear with an otoscope and may include a hearing test (audiometry) to assess the extent of any hearing loss.
- Healing and Treatment: Most small perforations heal naturally within a few weeks. The key to recovery is keeping the ear dry and avoiding objects in the ear canal. For larger tears that don't heal, a surgical repair called tympanoplasty may be recommended.
- Safety: While healing, it is crucial to avoid swimming and flying, as these can introduce infection or worsen the tear. If symptoms persist beyond a few days, medical attention is required to prevent long-term damage or chronic infection.
A perforated eardrum, also known as a tympanic membrane rupture, is a common condition affecting the ear that can cause discomfort, changes in hearing, and occasionally ear infections. At Resonate Health, we understand that an ear injury can be worrying, so this guide aims to provide clear information on what causes a perforated eardrum, how to recognise symptoms, how it’s diagnosed, and what to expect during healing.
What is a Perforated Eardrum?
Your eardrum is a thin, delicate membrane that separates the outer ear canal from the middle ear. It plays a crucial role in hearing by capturing sound wave energy and transmitting that energy via tiny bones in the middle ear to the cochlea, where that energy is converted into signals that the brain ultimately receives and interprets.
A perforated eardrum means there is a hole or tear in this delicate membrane. The size of the perforation can vary which can affect the severity of symptoms and the impact on one’s hearing. Sometimes the hole heals naturally, but in some cases, medical treatment may be needed.
Causes of a Perforated Eardrum
Several factors can cause your eardrum to perforate, including:
- Middle ear infections (otitis media): Fluid from the infection can sometimes build up behind the eardrum causing it to rupture from the pressure.
- Barotrauma: Rapid changes in pressure, such as during air travel, deep sea diving, or a sudden impact. Learn more about Barotrauma.
- Injury or trauma: Direct injury to the ear canal from objects like cotton buds, or hairpins, or a slap/blow to the ear.
- Loud noises or explosions: Sudden, intense sound energy from a loud blast or shockwave (e.g., from industrial accidents, gun blast or explosions) can sometimes cause the eardrum to rupture.
- Foreign objects: Inserting objects into the ear canal can cause the membrane to tear accidentally.
Symptoms to Watch For
A perforated eardrum usually presents with one or more of the following symptoms:
- Sudden sharp ear pain or discomfort (may quickly subside)
- Hearing loss in the affected ear (ranging from mild to significant)
- Drainage of fluid from the ear, which can be clear, pus-filled, or bloody
- Ringing or buzzing sounds (tinnitus)
- A feeling of fullness or pressure in the ear
- Vertigo or dizziness in some cases
- Sensitivity to loud sounds
If you experience any of these symptoms, especially after an injury or infection, it’s important to seek assessment.
How is a Perforated Eardrum Diagnosed?
Diagnosis is typically made by an audiologist, ENT specialist, or general practitioner through:
- Medical history: Discussing your symptoms, recent infections, injuries, or exposure to loud noises.
- Otoscopy: A simple examination using an otoscope, a small lighted instrument to look inside your ear canal and check the eardrum for a perforation.
- Hearing tests (audiometry): To assess the presence and extent and type of any resulting hearing loss.
- Tympanometry: A test that measures eardrum movement and can help detect and confirm a perforation.
Early diagnosis helps prevent complications and ensures proper management.
Healing Time and Treatment
Most small perforations heal on their own within a few weeks to two months. During this time, protecting the ear is vital to prevent infection and further damage.
Treatment approaches include:
- Keeping the ear dry: Avoid swimming, diving, or getting water in your ear while it is healing. Use earplugs or waterproof covers when showering or bathing.
- Avoid inserting objects: Do not put cotton buds swabs or other items in the ear canal (remember the old saying: never put anything smaller than your elbow in your ear canal).
- Pain management: Over-the-counter pain relievers may be recommended for discomfort.
- Antibiotics: If an infection is present or at risk, your doctor may prescribe ear drops or oral antibiotics.
- Surgical repair: In cases where the perforation does not heal naturally after several months, a minor surgical procedure called tympanoplasty may be recommended to close the hole.
Coping Strategies During Recovery
Living with a perforated eardrum can be uncomfortable, but these strategies can help you cope:
- Protect your ear: Use earplugs or waterproof covers when showering or bathing. Avoid exposing your ear to loud noises.
- Follow medical advice: Adhere strictly to your healthcare provider’s instructions on medication and follow-up appointments.
- Monitor for infection: Stay informed about symptoms of infection, such as increased pain, swelling, fever, or worsening discharge, and seek care promptly.
- Manage pressure: Keep your head elevated to reduce ear pressure and aid drainage if infection is present.
Perforated Eardrum Frequently Asked Questions (FAQ)
Find answers to some of our most frequently asked questions regarding perforated eardrums
A perforated eardrum is a hole or tear in the thin membrane that separates your outer and middle ear. It’s important because a perforation can cause hearing loss, discomfort, and make your ear more vulnerable to infections. Proper care helps avoid complications and supports healing.
Common signs include sudden, sharp ear pain that might quickly subside, usual fluid draining from the ear, hearing loss in the affected ear, ringing (tinnitus), or dizziness. An ear specialist or GP can confirm this with an examination using an otoscope.
Most small perforations heal naturally within 2 to 8 weeks. Larger tears or complicated cases, especially with infection, may take longer and might require a minor surgical procedure called tympanoplasty to close the hole.
If treated properly and without complications, such as chronic ear infection, hearing often returns to normal. However, large or persistent perforations, or those that recur with repeated infections, may cause permanent hearing damage. Prompt medical attention greatly reduces this risk.
Flying with an untreated perforation can cause significant discomfort and potentially worsen the tear due to changes in air pressure. Swimming should generally be avoided to prevent water from entering the middle ear and causing infection. Always consult your doctor before engaging in these activities while your eardrum is healing.
I’m James, a Tassie-born audiologist who moved to Aotearoa six years ago and never looked back.