Perforated Eardrum (Ruputured Eardrum)

Facts and definition of perforated (ruptured) eardrum

  • The eardrum (tympanic membrane) is a thin, oval layer of tissue deep in the ear canal that helps protect the delicate middle and inner ear from the outside. Because it is so thin, the eardrum can be ruptured or perforated, exposing the ear to damage or infection.
  • The main causes of perforated eardrum are infection of the middle ear or trauma to the ear or head.
  • Symptoms and signs of perforated eardrum include
  • ear pain,
  • Seek medical care for a perforated eardrum if you have difficulty walking, changes in hearing, severe spinning sensation, or your head goes under water. Seek emergency medical treatment if you have a stiff neck, high fever, "the worst headache of your life," numbness or tingling, difficulty speaking, vomiting, vision changes, or difficulty staying awake.
  • A health-care professional can tell if you have a ruptured eardrum by using an otoscope, which is an instrument that has a magnifier with a light, designed to look inside the ear. Other tests may include a tympanogram (a burst of air against the eardrum), or an audiogram (hearing test).
  • Most of the time, a perforated eardrum will heal on its own within two months.
  • If treatment is necessary, it may include pain relievers and antibiotics. In some cases, surgery is require to repair the rupture.
  • Not all cases of perforated eardrum can be prevented, but you can lower your risk by treating ear infections, avoiding flying or scuba diving if you have a sinus or upper respiratory tract infection, not putting anything in your ear, and wearing proper ear protection when needed.
  • Most ruptured eardrums will heal on their own within two months with no long-term symptoms. In rare cases, infection can spread to the brain or skull, requiring immediate medical attention.
Picture of the inner and outer structures of the ear
Picture of the inner and outer structures of the ear

What is a perforated (ruptured) eardrum?

A perforated (ruptured) eardrum is a hole or tear in the eardrum.

  • The eardrum (tympanic membrane) is a thin, oval layer of tissue deep in the ear canal.
  • It is called an eardrum because it looks and acts like a drum.
  • The eardrum helps protect the delicate middle and inner ear from the outside, and it receives vibrations from the outer ear and transmits them to the small hearing bones (ossicles), of the middle ear.
  • Because the eardrum is so thin, it can be ruptured or punctured. The hole or tear exposes the middle and inner ear to damage or infection.
  • An eardrum rupture is also called a tympanic membrane perforation.

What are the signs and symptoms of a perforated (ruptured) eardrum?

Ear pain is the most common symptom of a perforated eardrum. The pain can include:

  • General discomfort
  • Immediate, sharp, or intense pain
  • Pain that suddenly gets better
  • A feeling as if something is not right with the ear

Other common symptoms and signs of perforated eardrum include:

  • Vertigo (spinning sensation)
  • Dizziness
  • Hearing changes
    • Often with ringing (tinnitus), buzzing, clicking, or other noise
  • Hearing loss
  • Fluid (may be clear or pus-colored) or blood draining from the ear

What are the causes of a perforated (ruptured) eardrum?

Infection of the middle ear is the most common cause of a ruptured eardrum.

  • Infections can be caused by viruses, bacteria, or fungi.
  • Infections increase the pressure behind your eardrum, stretching the drum and causing pain.
  • When the eardrum can no longer stretch, it bursts or tears.
  • Frequently, the pain gets better, because the pressure is now relieved, however, sometimes the pain can get worse.

Trauma can also cause perforation.

  • Blunt or penetrating trauma, such as from a fall on the side of your head or a stick that goes deep in your ear
  • Rapid changes in pressure, for example, scuba diving (barotrauma, ear pain, or ear squeeze)
  • Slaps to the ear, such as a fall while water skiing or a hand slap to the side of the head
  • Lightning blasts
  • Blast waves from gunshots, fireworks, and other loud noises or explosions
  • Changes in air pressure during air travel or scuba diving
  • Sharp objects or cotton-tipped swabs
  • Motor vehicle accidents
  • Falls
  • Sports injuries

How can a doctor tell if you have a perforated (ruptured) eardrum?

The doctor can diagnose eardrum rupture by taking a history and looking in the patient's ear with an otoscope - a special magnifier with a light.

  • Occasionally, very small holes can be difficult to identify and may require further testing.
  • Tympanogram is a test that uses a short burst of air against the eardrum
  • Audiogram is a hearing test

Can you fly with a perforated (ruptured) eardrum?

It is safe to fly on an airplane when you have a perforated eardrum. However, if you have recently had surgery to repair a perforated eardrum, your doctor may advise you to not fly while it is healing.

What is the treatment for a perforated (ruptured) eardrum?

  • Because most perforated eardrum injuries heal on their own within two months, treatment may include analgesics to alleviate pain and antibiotics to prevent infection.
  • The doctor will likely advise the patient to keep the ear clean and dry while healing. This means swimming and scuba diving are not advised until a doctor says it is safe to do so.

If the perforated eardrum is due to a foreign object in the ear, do not try to remove it yourself. Only a medical professional should attempt to remove any foreign bodies in the ear.

What Are the Signs and Symptoms of an Earache?

The most common symptom of an earache is ear pain. Other symptoms associated with the earache depend upon the cause, and may include:

  • Swelling
  • Fever
  • Itching
  • Draining
  • Ringing in the ear
  • Decreased hearing
  • Nausea
  • Vomiting

How long does it take a perforated (ruptured) eardrum to heal?

After a few weeks, the patient should notice no long-term symptoms. Perforated eardrums generally heal within two months, and any accompanying hearing loss is usually temporary. Rarely, a dangerous infection can spread into the brain or skull. This requires immediate hospitalization or surgery. Also, if the patient has symptoms of severe dizziness and vomiting, facial paralysis, or hearing loss, more extensive surgery of the inner or middle ear may be required beyond patching the eardrum.

What about surgery to fix a perforated (ruptured) eardrum?

Some large holes or non-healing small holes require surgery.

Surgical procedures are performed with a general anesthetic. Most people go home from the hospital or clinic on the same day.

  • An ear, nose, and throat specialist (ENT, otolaryngologist) may graft or patch the eardrum with paper, fat, muscle, or other material.
  • These materials act as a bridge, allowing the tympanic membrane to grow together.

Which specialties of doctors treat a perforated (ruptured) eardrum?

A primary care provider (PCP) such as a family practitioner, an internist, or child’s pediatrician may diagnose a perforated eardrum. You may also see an emergency medicine specialist in a hospital’s emergency department.

Most perforated eardrums heal on their own, but if you need further treatment such as a patch or surgery, you may see an otolaryngologist (ear, nose, and throat specialist, or ENT).

When to seek medical care for a perforated (ruptured) eardrum

Call a doctor immediately if you suspect you or someone you know has a ruptured eardrum and any of the following occur:

  • An uncontrolled spinning sensation
  • Difficulty walking
  • An abrupt change in hearing
  • A change in the ability to taste foods
  • You accidentally put your ear under water

The following symptoms suggest a potentially life-threatening complication and require immediate medical evaluation:

  • Stiff neck
  • High fever
  • The worst headache of your life
  • Numbness or weakness in face, arms, or legs
  • Difficulty talking or opening mouth
  • Continued vomiting
  • Pain or swelling behind the ear
  • Abrupt change in vision
  • Difficulty staying awake

Can a perforated (ruptured) eardrum be prevented?

Some causes of ruptured eardrums cannot be prevented or avoided. A little caution can lower the risk.

  • Treat ear infections early.
  • Avoid flying or scuba diving if you have sinus infection or upper respiratory tract infection.
  • If you must fly or scuba dive, pinch your nose and swallow air frequently to help equalize the pressure.
  • Never put anything in your ear, even to clean it (for example, Q-Tips).
  • Wear proper ear protection such as ear plugs or protection designed for sports activities.

What does a perforated (ruptured) eardrum look like (pictures)?

A normal tympanic membrane (eardrum).
A normal tympanic membrane (eardrum). Click to view larger image.

A perforated tympanic membrane
A perforated tympanic membrane Click to view larger image.

A type of ear protection for water sports such as skiing, windsurfing, wakeboarding, or parasailing.
A type of ear protection for water sports such as skiing, windsurfing, wakeboarding, or parasailing. Click to view larger image.

Ear protection for prevention of blast injuries typically caused by firearms.
Ear protection for prevention of blast injuries typically caused by firearms. Click to view larger image.

Reviewed on 11/21/2017
Sources: References

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