A perforated eardrum is a hole or rupture in the eardrum, a thin membrane that separates the ear canal and the middle ear. A perforated eardrum is often accompanied by decreased hearing and occasional discharge with pain. The amount of hearing loss experienced depends on the degree and location of perforation. Sometimes a perforated eardrum will heal spontaneously, other times surgery to repair the hole is necessary. Serious problems can occur if water or bacteria enter the middle ear through the hole.

Eardrum

The eardrum is a thin membrane that separates the ear canal and the middle ear. The medical term for eardrum is “tympanic membrane.” The middle ear is connected to the nose by the eustachian tube, which equalizes pressure in the middle ear.

Eardrum Perforation

This is a hole in the thin membrane that separates the outer ear from the middle ear space. A perforated eardrum is often accompanied by decreased hearing and sometimes liquid discharge. The perforation may be accompanied by pain, if it is caused by an injury or becomes infected.

Causes

The causes of an eardrum hole are usually from injury, infection, or chronic eustachian tube disorders. A perforated eardrum from trauma can occur:

  • If the ear is struck directly
  • With a skull fracture
  • After a sudden explosion
  • If an object (such as a bobby pin, Q-tip, or stick) is pushed too far into the ear canal
  • Middle ear infections may cause pain, hearing loss, and spontaneous rupture of the eardrum, resulting in a perforation. In this case, there may be infected or bloody drainage from the ear. Infections can cause a hole in the eardrum as a side effect of otitis media. Symptoms of acute otitis media (middle ear fluid with signs of infection) include a sense of fullness in the ear, some hearing loss, pain, and fever.
  • In patients with chronic eustachian tube problems, the eardrum may become weakened and open up.
  • On some occasions, a small hole may remain in the eardrum after a previously placed pressure-equalizing (PE) tube falls out or is removed by a physician.

Hearing Loss with a Perforated Eardrum

Usually the size of the perforation determines the level of hearing loss. A larger hole will cause greater hearing loss than a smaller hole. A severe injury (e.g., skull fracture) can dislocate the bones in the middle ear that transmit sound causing hearing loss. Severe injuries to the inner ear can be severe enough to cause permanent, complete hearing loss.

If the perforated eardrum is caused by a sudden traumatic or violent event, the loss of hearing can be great and tinnitus (ringing in the ear) may occur. Chronic infection as a result of the perforation can cause longer lasting or worsening hearing loss.

A hearing test is often performed and can determine the severity and type of hearing loss.

How is a perforated eardrum treated?

Most eardrum holes resulting from injury or an acute ear infection heal on their own within weeks of opening, although some may take several months to heal. During the healing process, the ear must be protected from water and trauma.

If the perforation is very small, an otologist or otolaryngologist may choose to observe the perforation over time to see if it will close on its own. He or she might try to patch or splint a patient’s eardrum in the office or operating room. This involves touching the edges of the eardrum and then placing a thin paper patch on the eardrum.

Eardrum perforations that do not heal on their own may require more extensive surgery called a tympanoplasty. The benefits of closing a perforation include prevention of water entering the middle ear while showering, bathing, or swimming (which could cause ear infection), improved hearing, and lessened tinnitus. It also may prevent the development of cholesteatoma (skin cyst in the middle ear), which can cause chronic infection and destruction of ear structures. Surgery is quite successful in repairing the perforation, with success rates usually around 95%. This is typically performed on an outpatient basis in a surgery center under general anesthesia. Usually with closure of the ear drum, hearing is improved. Depending on the treatment given, it may take weeks or months before the final hearing outcome is reached.

The physicians at the Midwest Ear Institute are experts at ear surgery and would be happy to evaluate your ear problem and recommend the best treatment.