A perforated or ruptured eardrum occurs when there is an opening in the membrane that separates the ear canal from the middle ear.
What is going on in the body?
The eardrum is the sheet of tissue between the external and middle ear. The external ear is formed by the auricle, which is the external ear flap, and the external ear canal. The middle ear is the air-filled space behind the eardrum that contains the three small bones for hearing.
The eardrum is an important barrier between the environment and the middle ear. It also vibrates to transmit sound, which is a part of the normal hearing mechanism. The eardrum may be ruptured due to trauma, such as a sharp blow to the external ear. It can also rupture when pressure builds up in the middle ear and pushes the eardrum outward. This happens most frequently in the case of an infection.
What are the causes and risks of the condition?
Following are some of the common causes of a ruptured eardrum:
- changes in barometric pressure, caused by activities such as flying in a plane or scuba diving
- ear infections, especially if the infections are severe
- holes left in the eardrum when ear tubes have fallen out and the eardrum doesn't repair itself
- insertion of cotton applicators or other small objects into the ear canal
- previous ruptures
- sudden explosion
- trauma, such as sports injuries that cause a blow to the side of the head
- welding burns from hot slag entering the ear canal
Sometimes, the eardrum is deliberately perforated when ear tubes are placed. A surgeon places these small tubes into the eardrum when a person has chronic ear infections. They allow drainage of infected material from the middle ear and lower the pressure within the middle ear.
What can be done to prevent the condition?
The following recommendations can help prevent some cases of ruptured eardrum.
Avoid scuba diving when an upper respiratory tract infection or active allergies are present.
Do not stick anything in the ear, such as cotton applicators, that could cause trauma.
Follow sports safety guidelines for children, adolescents, and adults.
- Seek treatment for an ear infection immediately from a healthcare professional, especially when the pain does not resolve promptly or the infection is associated with a fever.
How is the condition diagnosed?
The diagnosis of a ruptured eardrum starts with a medical history and physical examination. Most holes in the eardrum can be seen during an examination with an otoscope. An otoscope is a lighted microscope with an air pump that is specially designed for the ear.
The healthcare professional may direct a small amount of air into the ear with the otoscope. When there is a hole in the eardrum, the air will not make the eardrum move. For very small holes, a tympanogram may be useful. A tympanogram measures eardrum movement and ear canal volume. A hearing test can measure the degree of the hearing impairment. A hearing test can show if there has been hearing loss because of damage to the nerves responsible for hearing.
Long Term Effects
What are the long-term effects of the condition?
The main reason to repair an eardrum is to provide a safe ear. An unrepaired eardrum puts the middle and inner ear at risk for damage from pressure or infection. Holes in the eardrum can affect hearing.
What are the risks to others?
A ruptured eardrum is not contagious and poses no risk to others.
What are the treatments for the condition?
When a hole in the eardrum is diagnosed, it is important to take the following steps.
- Avoid blowing the nose.
- Avoid changes in elevation.
- Keep contaminated or soapy water out of the ear canal.
Most ruptures caused by trauma, ear infections, and ear tubes will heal on their own. But some ruptures may require surgery. Patches of paper or fat are used to repair small holes. For larger holes, tissue is usually taken from the chewing muscle located in the temple. This tissue is then placed under the eardrum or on its surface. It acts as a scaffold for the drum to heal over.
What are the side effects of the treatments?
Surgery may be complicated by bleeding, infection, or reactions to anesthesia. Ear surgery may also cause hearing impairment.
What happens after treatment for the condition?
If treatment is successful, the protective barrier effect of the eardrum is restored. The person's hearing returns to a completely normal state.
How is the condition monitored?
Hearing should improve as the hole closes. If this does not happen, there may be another rupture. Anyone with a known rupture who gets water in the middle ear should consult a healthcare professional immediately so that antibiotic eardrops can be prescribed if needed.
A person who has continued or recurrent episodes of ear drainage may have a chronic ear infection. These or any other new or worsening symptoms should be reported to a healthcare professional.