What Causes a Perforated Eardrum?

A perforated eardrum is a hole or tear in the thin piece of tissue (the eardrum) that separates the outer ear from the middle ear. Many people experience a perforated eardrum at some point in their lifetime. In most cases, it heals naturally without long-term complications; however, in more serious cases, you may need to consult an audiologist or an ear, nose and throat specialist.

Your eardrum vibrates when sound reaches it, helping turn those vibrations into signals which your brain recognises as sound. It also acts as a barrier keeping water, foreign bodies or germs out of the middle ear. If this membrane ruptures, it is called a perforation.

There are a few common reasons why an eardrum can become perforated:

• Infection — middle ear infections can build up pressure until the eardrum ruptures.
• Rapid changes in pressure — pressure changes, such as during flying or scuba diving, can stress the eardrum and cause a rupture.
• Loud noise or blast — explosions and very loud sounds can rupture the membrane.
• Objects in the ear — poking into the ear canal with cotton buds or other items can accidentally puncture the eardrum.
• Head or ear injury — a fall, blow to the ear, or other trauma can cause a tear.

You might notice a mix of these symptoms:

• Hearing changes
• Tinnitus
• Ear pain
• Discharge or blood
• Dizziness

Not everyone will experience all of these symptoms, and some people may only feel mild discomfort.

A health professional will look inside your ear with a small lighted tool called an otoscope to see whether there is a perforation. A hearing assessment may be done to understand how much the perforation is impacting your hearing.

Most perforated eardrums heal by themselves within a few weeks to a couple of months, especially if the ear stays dry and protected.

During healing, it's important to:

• Avoid water entering the ear (swimming or showering)Not put anything in the ear canal (even cotton buds)
• See your doctor if you suspect an ear infection
• Avoid further injury, helping the tear close, and reducing the chance of infection

Most small tears don't need active treatment and heal naturally, but some situations may need professional care, including:

• The perforation doesn't heal after a few months
• Ongoing hearing loss
• Repeated ear discharge or infection

In these cases, a specialist may suggest a small procedure such as myringoplasty or tympanoplasty to close the hole. These procedures use a tiny patch or tissue graft to help the eardrum heal.