Insight into ear injuries
- What is a perforated eardrum?
- What causes eardrum perforation?
- How is hearing affected by a perforated eardrum?
- and more…
A hole or rupture in the eardrum, a thin membrane that separates the ear canal and the middle ear, is called a perforated eardrum. The medical term for eardrum is tympanic membrane. The middle ear is connected to the nose by the eustachian tube, which equalizes pressure in the middle ear. A perforated eardrum is often accompanied by decreased hearing and occasional discharge. Pain is usually not persistent.
What causes eardrum perforation?
The causes of a perforated eardrum are usually from trauma or infection. A perforated eardrum from trauma can occur:
- If the ear is struck directly
- With a skull fracture
- After a sudden explosion
- If an object (such as a bobby pin, Q-tip, or stick) is pushed too far into the ear canal
- As a result of acid or hot slag (from welding) entering the ear canal
Middle ear infections may cause pain, hearing loss, and spontaneous rupture (tear) of the eardrum, resulting in a perforation. In this circumstance, there may be infected or bloody drainage from the ear. In medical terms, this is called otitis media with perforation. Symptoms of acute otitis media include a sense of fullness in the ear, diminished hearing, pain, and fever. On rare occasions, a small hole may remain in the eardrum after a previously placed pressure-equalizing (PE) tube falls out or is removed by the physician. Most eardrum perforations heal on their own within weeks of rupture, although some may take several months to heal. During the healing process, the ear must be protected from water and trauma. Eardrum perforations that do not heal on their own may require surgery.
How is hearing affected by a perforated eardrum?
Usually, the size of the perforation determines the level of hearing loss – a larger hole will cause greater hearing loss than a smaller hole. The location of the perforation also affects the degree of hearing loss. If severe trauma (e.g., skull fracture) dislocates the bones in the middle ear which transmit sound or injures the inner ear structures, hearing loss may be severe. If the perforated eardrum is caused by a sudden traumatic or explosive event, the loss of hearing can be great and tinnitus (ringing in the ear) may be severe. In this case, hearing usually returns partially, and the ringing diminishes in a few days. Chronic infection as a result of the perforation can cause persistent or progressive hearing loss.
How is a perforated eardrum treated?
Before attempting any correction of the perforation, a hearing test should be performed. The benefits of closing a perforation include prevention of water entering the ear while showering, bathing, or swimming (which could cause ear infection), improved hearing, and diminished tinnitus. It also may prevent the development of cholesteatoma (skin cyst in the middle ear), which can cause chronic infection and destruction of ear structures.
If the perforation is very small, an otolaryngologist may choose to observe the perforation over time to see if it will close spontaneously. He or she might try to patch a patient’s eardrum in the office. Working with a microscope, your doctor may touch the edges of the eardrum with a chemical to stimulate growth and then place a thin paper patch on the eardrum. Usually, with the closure of the tympanic membrane, hearing is improved. Several applications of a patch (up to three or four) may be required before the perforation closes completely. If your physician feels that a paper patch will not provide prompt or adequate closure of the hole in the eardrum, or if paper patching does not help, surgery may be required.
There are a variety of surgical techniques, but most involve grafting skin tissue across the perforation to allow healing. The name of this procedure is called tympanoplasty. Surgery is typically quite successful in repairing the perforation, restoring or improving hearing, and is often done on an outpatient basis. Your doctor will advise you regarding the proper management of a perforated eardrum.
Frequently Asked Questions
A perforated eardrum is a hole or rupture in the tympanic membrane, which is a thin membrane that separates the ear canal from the middle ear. This condition often leads to decreased hearing and sometimes ear discharge, though persistent pain is uncommon.
Perforated eardrums can result from trauma such as direct injury to the ear, skull fractures, sudden explosions, or inserting objects like Q-tips too far into the ear canal. Middle ear infections may also cause spontaneous rupture of the eardrum, leading to perforation, sometimes accompanied by infection or bleeding.
The degree of hearing loss depends mainly on the size and location of the perforation; larger or strategically located holes typically cause more significant hearing loss. Severe trauma can cause hearing loss due to damage to the middle ear bones or inner ear structures. In many cases, hearing improves as the eardrum heals, but chronic infections can lead to ongoing hearing loss.
Symptoms include a feeling of fullness in the ear, diminished hearing, pain, fever, and sometimes infected or bloody drainage from the ear. These symptoms can precede a spontaneous tear or rupture of the eardrum known as otitis media with perforation.
Treatment begins with a hearing test. Small perforations may heal on their own or be treated with a paper patch applied by a specialist to stimulate healing. If patching is unsuccessful or the perforation is large, surgical repair called tympanoplasty is performed, which involves grafting skin tissue over the hole to restore the eardrum and improve hearing.
During healing, it is important to protect the ear from water and trauma to prevent infection and further damage. Avoiding swimming and keeping the ear dry while showering or bathing helps the eardrum to heal properly.
Yes, if left untreated, a perforated eardrum may cause chronic infections, persistent or progressive hearing loss, and the development of cholesteatoma, a skin cyst in the middle ear that can destroy ear structures and cause further complications.
