Perforated eardrum

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at June 24, 2016
StartDiseasesPerforated eardrum

A perforated eardrum or ruptured eardrum is a tear in the membrane separating the inner ear from the outer ear. It can come on suddenly with a sharp pain or present as sudden relief to chronic ear pain. For a few people it can cause infection and hearing loss, but for most people simply protecting the ear will encourage healing within a few months without treatment.

Contents

Definition & Facts

The eardrum is also known as the tympanic membrane and is a thin membrane that separates the inner ear from the outer ear. This membrane vibrates with sound waves and converts them to nerve impulses that can be interpreted by the brain. It protects the middle ear from infection and keeps the area sterile. When there is a perforation or a hole, the middle ear can acquire infection, known as otitis media, and it can also interfere with the body’s sense of balance.

Symptoms & Complaints

While some people don’t notice any symptoms at all, many people feel pain, discomfort, or a sensation of something not quite right with the ear. Often this pain continues for days but then subsides suddenly.

Other signs are visible such as blood, pus, or clear drainage from the ear canal. Some people experience vertigo or dizziness as the equilibrium of the inner ear is compromised. Others hear a buzzing or strange sound inside the ear.

Every once in a while, people complain of hearing air sounds passing through the eardrum. When someone blows his or her nose forcefully, air is forced into the ear and the eardrum expands in response. If there is a perforation, the air passes through and can be felt or heard. The passing air can sometimes be loud enough to be heard by other people.

Causes

There are a few common causes of ruptured eardrum. The first is an infection in the middle ear that causes fluid to accumulate. The pressure from this fluid can put stress on the membrane and cause it to rupture. Another cause is a sudden loud noise, such as that from a gunshot or explosion. The sound waves overwhelm the membrane causing it to tear.

Extreme changes in pressure, also called barotrauma are another cause. Diving or flying are examples of activities that can trigger this change in pressure, and ear barotrauma is sometimes known as airplane ear due to the number of people that experience these occurrences during flights.

Ruptured eardrums can also be caused by foreign objects in the eardrum, like the insertion of a cotton swab during cleaning. This cause is especially common for children. Trauma to the head or a skull fracture can sometimes be severe enough to impact the eardrum. The deployment of airbags can cause damage to the inner and outer ear including the eardrum.

Diagnosis & Tests

When there are symptoms of a ruptured eardrum, a doctor will perform an otoscopic exam. The otoscope is an instrument with a light that examines the inner ear. Most of the time, if there is a tear or perforation, the doctor will see it immediately. The doctor might also ask questions about loud noises or changes in pressure to further confirm the diagnosis.

If earwax prevents the doctor from making a diagnosis, he or she might prescribe drops to clear the wax first. The doctor might also use a rubber tube attached to the otoscope to blow air onto the eardrum. If the drum moves, there isn’t a tear; if the drum does not move, there is most likely perforation. Another test is called tympanometry which is the use of a device inserted into the ear that measures membrane movement in response to slight changes in air pressure.

The doctor may order lab tests of any discharge to determine if an infection is present. The doctor may also test hearing to determine any loss due to the rupture. Testing is done with a tuning fork or other audiology equipment. Although hearing loss is common with a tear, most people regain full hearing when the membrane is completely healed.

Treatment & Therapy

Usually, no treatment is needed for a ruptured eardrum, and the vast majority heal within a few months. Care should be taken to avoid rupturing the eardrum further and to keep water from entering the ear while the membrane is healing. The doctor may also prescribe an antibiotic to prevent infection until the membrane is able to maintain the sterility of the inner ear.

For pain, doctors recommend over-the-counter medications such as ibuprofen or acetaminophen. Heat therapy can also relieve some of the pain. If the rupture is slow to heal, the doctor might need to place a patch over the ear to further protect it.

In some extreme cases, such as a very large tear, surgery is needed to repair the damage. Surgery is usually outpatient, and takes only a few hours. After surgery, care should be taken to keep the eardrum dry and clean, and to protect it from cold air. Patients should also take all medicine prescribed after surgery.

Prevention & Prophylaxis

The first way to prevent rupture is never insert anything into the ear even to clean it. One should not try to remove hardened wax with a cotton swab or other devices. If a foreign object becomes lodged in the ear, a doctor should remove it, rather than the patient trying removal at home.

The second way to prevent ruptured eardrums is to treat ear infections immediately to prevent fluid from rupturing the membrane. Signs of an ear infection are fever, earache, and symptoms of an upper respiratory tract infection.

One should guard against loud excessive noise by wearing protective ear pieces during work, concerts, or other activities where loud noise is certain. Professional musicians exposed to loud sounds on an occupational basis should consider getting custom molded earplugs.

It’s also important to protect the ears during changes in pressure. When flying, one should protect the ear with pressure equalizing earplugs, or try to mitigate pressure by chewing gum during takeoff and landing.