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 Otitis Media (Acute) Acute otitis media is a bacterial or viral infection of the middle ear. Acute otitis media often occurs in people with a cold or allergies. The infected ear is painful. Doctors examine the eardrum... read more 
) 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 Barotrauma of the Ear Barotrauma is an injury caused by increased air pressure, such as during airplane flights or scuba diving. Barotrauma can cause ear pain or damage to the eardrum. The eardrum separates the ear... read more ). A perforation may occur when doctors irrigate the ear canal or remove a foreign object Objects in the Ear Objects in the ear can be removed by flushing the ear canal with sterile water or saline or using suction, forceps, or other tools. If the foreign body cannot easily be removed, a referral to... read more .
Symptoms of Eardrum Perforation
A middle ear infection (otitis media Otitis Media (Acute) Acute otitis media is a bacterial or viral infection of the middle ear. Acute otitis media often occurs in people with a cold or allergies. The infected ear is painful. Doctors examine the eardrum... read more ) 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 Ear Ringing or Buzzing Ringing in the ears (tinnitus) is noise originating in the ear rather than in the environment. It is a symptom and not a specific disease. Tinnitus is very common—10 to 15% of people experience... read more ). 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 of Eardrum Perforation
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 of Eardrum Perforation
Antibiotics if needed
Sometimes surgery
The ear is kept dry. Usually, no specific treatment is needed for eardrum perforation 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 suppurative otitis media Otitis Media (Chronic Suppurative) Chronic suppurative otitis media is a long-standing, persistently draining perforation of the eardrum (tympanic membrane). Acute otitis media and blockage of a eustachian tube are among the... read more 
—in the middle ear.
A persistent conductive hearing loss Causes 
(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 Causes (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.
