Perforated eardrum

Overview

A perforated eardrum is a hole or tear in the thin tissue that separates your ear canal from your middle ear. This tissue, called the eardrum, helps you hear by vibrating when sound waves hit it. When it is torn, your hearing can be affected, and the middle ear becomes more vulnerable to infections.

Perforated eardrum is quite common, especially in children. Many people experience it at least once in their lifetime, often as a result of a middle ear infection.

It can affect people of all ages, but children are more likely to get ear infections that lead to a perforated eardrum. Adults may experience it from trauma, sudden loud noises, or pressure changes during flying or diving.

Symptoms

Common symptoms

• Ear pain that may suddenly decrease once the eardrum ruptures
• Hearing loss (usually mild to moderate)
• Fluid or blood draining from the ear
• Ringing (tinnitus) in the affected ear
• A feeling of fullness or pressure in the ear

Symptoms in children

• Children may have a fever along with ear pain
• They might tug at the affected ear or be irritable
• Fluid or pus may be seen coming out of the ear

Symptoms in older adults

• Older adults may notice hearing loss more than pain
• They might feel dizzy or have balance problems
• Discharge from the ear can be a sign of infection

Causes

Main causes

• Middle ear infection (otitis media) – pressure from pus can cause the eardrum to burst
• Sudden changes in air pressure (barotrauma) – from flying, scuba diving, or a slap to the ear
• Inserting objects into the ear – like cotton swabs, hairpins, or keys
• Loud noises (acoustic trauma) – such as an explosion or a very loud concert nearby
• Head injury – a fracture of the skull can also damage the eardrum

Risk factors

• Frequent or severe middle ear infections
• Young age (children's eustachian tubes are shorter and more prone to infection)
• Activities that involve rapid pressure changes (flying, diving, skydiving)
• Using objects to clean the ear canal
• Having a previous ear surgery or chronic ear problems

When to see a doctor

See a doctor urgently if:

• If you have sudden hearing loss or severe pain
• If you see pus, blood, or fluid coming from your ear
• If you feel dizzy or have trouble balancing
• If you have a fever with ear symptoms

Book a routine appointment if:

• If you have mild hearing loss or a feeling of fullness that lasts more than a few days
• If you have had a perforated eardrum before and it hasn't healed after a month
• If you are worried about a possible ear injury, even if symptoms are mild

Diagnosis

A doctor can usually see the tear by looking into your ear with a lighted instrument called an otoscope. They may also use a special magnifying tool (otoscope with a working channel) or a microscope for a closer look.

Tests that may be done

• Otoscopy – the doctor looks inside the ear canal and at the eardrum
• Audiometry (hearing test) – to check how well you hear sounds of different pitches
• Tympanometry – a quick test that uses air pressure to see how the eardrum moves

What to expect at your appointment

The exam is painless and usually takes just a few minutes. The doctor may also gently clean any discharge from your ear to get a clearer view. If an infection is present, they might take a sample of the fluid to identify the germ causing it.

Treatment

Most perforated eardrums heal on their own within a few weeks, especially if you keep the ear dry and avoid further trauma. Treatment focuses on preventing infection and helping the eardrum heal. If the tear is large or does not heal after a few months, medical or surgical treatment may be needed.

Self-care at home

• Keep the ear dry – avoid swimming and use a cotton ball coated with petroleum jelly in the outer ear when showering
• Do not put anything in the ear – no earplugs, drops, or objects unless your doctor advises it
• Blow your nose gently to avoid increasing pressure in the ear
• Avoid flying or scuba diving until the eardrum has healed

Medical treatments

If there is an infection, the doctor may prescribe antibiotic ear drops or oral antibiotics. You may also be given pain relievers. For persistent discharge, the doctor might clean the ear gently or place a patch (paper or gel) over the tear to promote healing.

When is surgery considered?

If the perforation is large or does not heal after several months, a minor surgery called tympanoplasty may be recommended. This involves grafting a small piece of tissue over the hole to repair the eardrum.

Living with this condition

While your eardrum heals, you need to keep the ear dry and avoid anything that could cause further injury. Your hearing may be a bit muffled, but that usually improves as the eardrum heals. Avoid swimming and protect your ear when bathing.

Lifestyle tips

• Avoid inserting objects like cotton swabs or fingers into the ear
• Wear earplugs or a shower cap when washing your hair
• Be careful when blowing your nose – do it gently, one nostril at a time
• Avoid loud environments or use hearing protection

Diet and exercise

No special diet is needed. You can continue with normal exercise, but avoid activities that put pressure on the ear, such as heavy lifting or intense straining. If you exercise in water, wait until your doctor says it is safe.

Mental health and emotional wellbeing

Hearing loss or ear discomfort can be frustrating, but remember that most cases heal and hearing returns to normal. If you feel anxious or upset, talk to a friend or your doctor. Temporary hearing changes rarely cause lasting emotional problems.

Prevention

Many perforated eardrums can be prevented by treating ear infections early, avoiding inserting objects into the ear, and taking precautions during activities that involve pressure changes.

Vaccines

Childhood vaccines, especially the pneumococcal and flu vaccines, can help prevent ear infections that may lead to a perforated eardrum.

Screening programmes

There is no routine screening for perforated eardrum. If you have frequent ear infections or hearing loss, your doctor can check your ears during regular visits.

Complications

If left untreated

• Persistent hearing loss that may become permanent
• Chronic middle ear infections (chronic otitis media)
• Cholesteatoma – a skin cyst in the middle ear that can damage ear bones
• Spread of infection to the mastoid bone (mastoiditis) or, rarely, to the brain

Long-term outlook

With proper care, most perforated eardrums heal within a few weeks, and hearing returns to normal. Even larger tears can often be repaired with surgery if needed. Long-term problems are uncommon when the condition is treated promptly.

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