A perforation is a hole in the eardrum.

• Eardrum perforations are often caused by middle ear infections.
• 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 cause of eardrum perforation. The eardrum can also be perforated by a sudden change in pressure—either an increase, such as that caused by an explosion, a slap, or diving underwater; or a decrease, such as occurs while flying in an airplane. Another cause is burns from heat or chemicals. The eardrum may also be perforated (punctured) by objects placed in the ear, such as a cotton-tipped 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).

Symptoms and Diagnosis

Perforation of the eardrum causes sudden severe pain, sometimes followed by bleeding from the ear, hearing loss, and noise in the ear (tinnitus—see Symptoms of Ear Disorders: Ear Ringing or Buzzing). 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 whirling sensation). Pus may begin to drain from the ear in 24 to 48 hours, particularly if water or other foreign material enters the middle ear. A doctor diagnoses eardrum perforation by looking in the ear with a special instrument called an otoscope. Sometimes formal hearing tests are performed.

Treatment

The ear is kept dry. An antibiotic given by mouth may be used if the ear becomes infected. Ear drops may be given for contaminated injuries. 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 (see Hearing Loss and Deafness: Causes) occurring after perforation of the eardrum suggests a disruption or fixation of the ossicles, which may be repaired surgically. A sensorineural hearing loss or vertigo that persists for more than a few hours after the injury suggests that something has injured or penetrated the inner ear.

Last full review/revision February 2008 by Richard T. Miyamoto, MD