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Eardrum Perforation

By Richard T. Miyamoto, MD, MS, Indiana University School of Medicine

A perforation is a hole in the eardrum.

  • Eardrum perforations are caused by middle ear infections and injuries.

  • Perforation causes sudden ear pain, sometimes with bleeding from the ear, hearing loss, or noise in the ear.

  • Doctors can see the perforation with an otoscope.

  • Usually the eardrum heals on its own, but sometimes surgical repair is needed.

A middle ear infection ( otitis media) is the most common non-injury cause of eardrum perforation.

The eardrum can also be perforated by a sudden change in pressure, either

  • An increase in pressure, such as that caused by an explosion, an open-handed slap, or diving underwater

  • A decrease in pressure, such as occurs while flying in an airplane or when strong suction is applied to the ear canal

Severe head injury may cause a perforation, particularly if the base of the skull near the ear is fractured.

The eardrum may also be perforated (punctured) by objects inserted in the ear, such as a cotton swab, or by objects entering the ear accidentally, such as a low-hanging twig or a thrown pencil. An object that penetrates the eardrum can dislocate or fracture the chain of small bones (ossicles) that connect the eardrum to the inner ear. Pieces of the broken ossicles or the object itself may even penetrate the inner ear. A blocked eustachian tube, which connects the middle ear and the back of the nose, may lead to the perforation because of severe imbalance of pressure ( barotrauma). A perforation may occur when doctors irrigate the ear canal or remove a foreign object.

Symptoms

A middle ear infection severe enough to cause perforation is usually quite painful because of the buildup of infected fluid (pus). In such cases, perforation allows pus to drain out of the ear, relieving the pressure and the pain.

Perforation of the eardrum by an injury causes sudden severe pain, sometimes followed by bleeding from the ear, hearing loss, and noise in the ear ( tinnitus). The hearing loss is more severe if the chain of ossicles has been disrupted or the inner ear has been injured. Injury to the inner ear may also cause vertigo (a false sensation of moving or spinning). Pus may begin to drain from the ear in 24 to 48 hours, particularly if water or other foreign material enters the middle ear.

Diagnosis

  • A doctor's evaluation

A doctor diagnoses eardrum perforation by looking in the ear with a special instrument called an otoscope. If possible, formal hearing tests are done before and after treatment.

Treatment

  • Antibiotics if needed

  • Sometimes surgery

The ear is kept dry. Usually, no specific treatment is needed unless the injury was caused by a dirty object or if contaminants may have entered through the perforation. In such cases, doctors give antibiotic ear drops or an antibiotic taken by mouth. Antibiotics also may be used if the ear becomes infected.

Usually, the eardrum heals without further treatment, but if it does not heal within 2 months, surgery to repair the eardrum (tympanoplasty) may be needed. People with a severe injury, particularly one accompanied by marked hearing loss, severe vertigo, or both, may need to have more immediate surgery. If a perforation is not repaired, the person may develop a smoldering infection— chronic otitis media—in the middle ear.

A persistent conductive hearing loss (hearing loss that occurs when sound is blocked from reaching the sensory structures in the inner ear) occurring after perforation of the eardrum suggests a disruption or fixation of the ossicles, which may be repaired surgically. A sensorineural hearing loss (when there is a problem with nerve impulses carried from the ear to the brain) or vertigo that persists for more than a few hours after the injury suggests that something has injured or penetrated the inner ear.

* This is the Consumer Version. *