Ruptured eardrum

Definition

A ruptured or perforated eardrum is an opening in the tympanic membrane (eardrum).

Alternative Names

Tympanic membrane perforation; Eardrum - ruptured or perforated; Perforated eardrum

Causes, incidence, and risk factors

The tympanic membrane (eardrum) separates the outer ear from the middle ear. The membrane vibrates when sound waves strike it, and this starts the process that converts the sound wave into a nerve impulse that travels to the brain. When the eardrum is damaged, the hearing process is interrupted.

The eardrum also acts as a barrier to keep outside material (such as bacteria) from entering the middle ear. When the eardrum is perforated, bacteria can easily travel to the middle ear -- causing an infection.

Damage to the eardrum can occur from acoustic trauma such as direct injury or barotrauma (pressure-induced damage). Inserting cotton-tipped swabs or small objects into the ear to clean them sometimes causes a perforation of the eardrum. Foreign objects in the ear are another cause of perforated eardrum.

Ear infections may cause a ruptured eardrum as the pressure of fluid in the middle ear increases. Conversely, a ruptured eardrum can cause ear infections because the eardrum is no longer intact, and bacteria can enter the middle ear.

Symptoms

• Drainage from the ear (drainage may be clear, pus, or bloody)
• Ear noise/buzzing
• Earache or ear discomfort
  • May be severe and increasing
  • There may be a sudden decrease in ear pain followed by ear drainage
• Facial weakness or dizziness (in more severe cases)
• Hearing loss in the affected ear (hearing loss may not be complete)

Signs and tests

The doctor will look in your ear with an instrument called an otoscope. If the eardrum is perforated, the doctor will see an opening in it, and may even see the bones of the middle ear.

Sometimes it is hard for the doctor to see the eardrum because of drainage (pus) from the ear.

Audiology testing can measure the extent of hearing loss.

Treatment

A ruptured or perforated eardrum usually heals by itself within 2 months. The goal of treatment is to relieve pain and prevent infection.

Antibiotics (oral or eardrops) may be used to prevent infection or to treat an existing infection. Analgesics (pain killers), including over-the-counter medications, may be used to relieve pain.

Occasionally, the health care provider may place a patch over the eardrum while it heals. Surgical repair of the eardrum may be needed, if the eardrum does not heal on its own (tympanoplasty).

Warmth to the ear may help relieve discomfort. Keep the ear clean and dry while healing. Cotton balls should be placed in the ear while showering or shampooing to prevent water entering the ear.

Expectations (prognosis)

A ruptured or perforated eardrum may be uncomfortable, but it usually heals by itself within 2 months. Any hearing loss is usually temporary.

Complications

• Ear infection (otitis media)
• Permanent hearing loss
• Spread of infection to the bone behind the ear (mastoiditis)

Calling your health care provider

Call your health care provider if you:

• Have symptoms of a ruptured or perforated eardrum
• Are diagnosed with a ruptured eardrum, and symptoms last longer than 2 months despite medical treatment
• Are diagnosed with a ruptured eardrum and develop a persistent fever, general ill feeling, or hearing loss

Prevention

Do not insert objects into the ear canal, even to clean it. Foreign objects should only be removed by a health care provider. Have ear infections treated promptly.

References

Bauer CA, Jenkins HA. Otologic symptoms and syndromes. In: Cummings CW, Flint PW, Haughey BH, Robbins KT, Thomas JR, eds. Otolaryngology: Head & Neck Surgery. 4th ed. Philadelphia, PA: Mosby Elsevier; 2005:chap 126.

Ramakrishnan K, Sparks RA, Berryhill WE. Diagnosis and treatment of otitis media. Am Fam Physician. 2007;76(11):1650-1658.