Bulging Eardrum

Overview

A bulging eardrum means the thin membrane at the end of your ear canal is being pushed outward. Doctors call this membrane the tympanic membrane. It usually happens when pressure or fluid builds up behind the eardrum, often during a middle ear infection or when the tube that drains the middle ear is blocked.

Yes. A bulging eardrum is a common reason for ear symptoms, especially in children. It is one of the ways clinicians describe what they see when there is pressure or infection behind the eardrum.

Anyone can get a bulging eardrum, but young children are affected most often because their Eustachian tubes are smaller and block more easily. Adults can also get it after a cold, flu, allergy flare-up, ear infection, or pressure change such as flying or diving.

Symptoms

Common symptoms

• Ear pain or a dull ache
• Muffled hearing or sounds that seem far away
• A feeling of fullness or pressure in the ear
• Fever, especially if there is an infection
• Fluid, pus, or blood coming from the ear if the eardrum has ruptured
• Ringing or buzzing in the ear
• Dizziness or a sense of imbalance

Symptoms in children

• Tugging, rubbing, or holding the ear
• Crying, irritability, or being hard to comfort
• Trouble sleeping or lying flat
• Poor feeding or less interest in eating
• Fever
• Hearing difficulties or not responding to soft sounds
• Balance problems or clumsiness
• Fluid or discharge from the ear

Symptoms in older adults

• A change in hearing or muffled hearing
• Ear fullness or pressure
• Dizziness or unsteadiness
• Symptoms after a cold, allergy, or sinus problem
• Less fever than younger people, so symptoms may be less obvious
• Repeated ear problems, especially if there are other health conditions

Causes

Main causes

• Middle ear infection, called otitis media, which can build up pus and pressure behind the eardrum
• A blocked Eustachian tube from a cold, flu, allergy, or sinus problem
• Fluid build-up behind the eardrum after an infection
• Pressure changes from flying, diving, or traveling to high altitudes
• Ear injury from inserting an object, a loud blast, or a head injury
• Rarely, growths or other problems in the ear or nearby tissue

Risk factors

• Being a young child, especially under 5 years old
• Being in daycare or around other children
• Recent cold, flu, or sinus infection
• Allergies that affect the nose and throat
• Tobacco smoke exposure
• Bottle-feeding while lying flat
• Pacifier use in young children
• Cleft palate or other differences in the shape of the ear and throat
• A weakened immune system
• Pressure changes from flying or diving
• Putting cotton swabs or other objects in the ear

When to see a doctor

See a doctor urgently if:

• Severe ear pain, especially with fever
• Fever in a baby or young child that is not settling
• Sudden hearing loss
• Discharge of fluid, pus, or blood from the ear
• Symptoms that are getting worse after 2 to 3 days
• Dizziness that is severe or not going away
• Swelling, redness, or tenderness behind the ear

Book a routine appointment if:

• Mild ear fullness or pain after a cold that lasts more than a few days
• Hearing that stays muffled for more than a week or two
• Repeated ear infections
• Fluid behind the eardrum found by a clinician
• Concern about a child’s hearing, speech, or balance
• A history of ear surgery or a hole in the eardrum

Diagnosis

A clinician will ask about your symptoms and look inside your ear with an otoscope, which is a small light with a cone-shaped tip. They may gently puff air into the ear to see if the eardrum moves and use a small device called a tympanometer to check pressure behind the eardrum. If hearing is affected or problems keep coming back, they may arrange a hearing test or refer you to an ear, nose, and throat specialist.

Tests that may be done

• Otoscope exam: looking at the eardrum with a light
• Pneumatic otoscopy: checking whether the eardrum moves with a small puff of air
• Tympanometry: a quick test of pressure and movement in the middle ear
• Hearing test, also called audiometry, if hearing loss is a concern
• Imaging such as a scan only if symptoms are unusual, severe, or not improving

What to expect at your appointment

The exam is usually quick and not painful. Some people find the puff of air or the pressure test a little odd but it passes quickly. If the cause is not clear or symptoms continue, your clinician may arrange follow-up or specialist review.

Treatment

Treatment depends on the cause, your age, and how severe the symptoms are. The main goals are to ease pain, treat infection if one is present, help fluid drain, and protect hearing. Not every bulging eardrum needs medicine. Your clinician will decide what is right for you and will explain the options.

Self-care at home

• Rest and drink enough fluids
• Use a warm compress on the outside of the ear if it feels comforting
• Sleep with your head slightly raised if that is more comfortable
• Ask your pharmacist or clinician about pain relief that is suitable for your age and health
• Do not put cotton swabs, oils, or other objects in the ear
• Keep the ear dry if there is discharge, and avoid swimming or diving until a clinician says it is safe
• Avoid tobacco smoke and other irritants

Medical treatments

If a bacterial infection is likely, a doctor may prescribe infection-fighting medicine. For fluid or pressure without a clear infection, watchful waiting and follow-up are common. A clinician may also suggest treatment for allergies or cold symptoms. Ear drops should only be used if a clinician advises them, because some drops can be harmful if the eardrum has a hole. Always ask before using any medicine, including over-the-counter products.

When is surgery considered?

Surgery is not common. An ear, nose, and throat specialist may suggest a small tube placed in the eardrum, sometimes called a grommet, if fluid remains for a long time or infections keep returning. Surgery may also be needed to repair an eardrum hole that does not heal. Your specialist will discuss the benefits and risks with you.

Living with this condition

Muffled hearing can make conversations tiring. Ask people to speak clearly and face you, reduce background noise when you can, and follow up with your clinician as advised. Children may need extra patience at home or school while their hearing settles.

Lifestyle tips

• Keep hands clean and avoid sharing cups or utensils during colds
• Keep away from tobacco smoke
• Manage allergies with help from your clinician or pharmacist
• Follow advice about flying, diving, or swimming if your ear is healing
• Keep up with routine vaccines and recommended flu vaccines
• Avoid putting anything into the ear canal

Diet and exercise

There is no special diet for a bulging eardrum. Eat balanced meals and drink enough fluids. Gentle activity is fine if you feel well. Avoid swimming or diving until a clinician says your ear is safe, especially if there is discharge or a possible hole in the eardrum.

Mental health and emotional wellbeing

Ear pain and hearing changes can be frustrating and can make you feel isolated, especially if you have to ask people to repeat themselves. This is common and worth mentioning to your clinician. If you feel overwhelmed or have thoughts of harming yourself, contact your local emergency number or a crisis service right away.

Prevention

Not all cases can be prevented, but you can lower the risk of ear infections and pressure problems. Good hand hygiene, avoiding smoke, managing allergies, and keeping vaccines up to date all help.

Vaccines

Keep up to date with routine childhood vaccines and recommended flu and pneumococcal vaccines where offered. Ask your clinician what is right for you or your child.

Screening programmes

There is no routine screening for a bulging eardrum. Hearing checks may be arranged if you or your child have symptoms, repeated ear infections, or concerns about hearing and speech.

Complications

If left untreated

• Fluid behind the eardrum that lasts for weeks or months and causes muffled hearing
• A hole or rupture in the eardrum, which often heals but may need review
• Spread of infection to the bone behind the ear, called mastoiditis
• Rarely, infection spreading to the inner ear or nearby areas
• Long-term hearing problems or repeated ear infections

Long-term outlook

Most people recover well, especially with good follow-up and treatment when needed. Hearing often returns as fluid clears. Some people need specialist care or repeat check-ups, but serious problems are uncommon. If symptoms do not improve, ask your clinician about the next steps.

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