What are the common causes of a ruptured eardrum. How can you recognize the symptoms of a perforated tympanic membrane. What treatment options are available for a damaged eardrum. How long does it typically take for a ruptured eardrum to heal.

Understanding the Anatomy of the Ear

The ear is a complex organ consisting of external, middle, and inner structures. The eardrum, also known as the tympanic membrane, plays a crucial role in the hearing process. It separates the outer ear from the middle ear and vibrates when sound waves strike it, initiating the process of converting sound waves into nerve impulses that travel to the brain.

The middle ear contains three tiny bones called ossicles – the malleus, incus, and stapes. These bones conduct sound from the eardrum to the cochlea in the inner ear. Understanding this anatomy is essential for grasping the implications of a ruptured eardrum.

What is a Ruptured Eardrum?

A ruptured eardrum, medically known as tympanic membrane perforation, is an opening or hole in the eardrum. This thin piece of tissue that separates the outer and middle ear can become damaged due to various factors, potentially affecting hearing ability.

The severity of a ruptured eardrum can vary from a small tear to a large hole. Regardless of size, any damage to this delicate structure warrants medical attention to prevent complications and ensure proper healing.

Common Causes of Eardrum Rupture

Several factors can lead to a ruptured eardrum. Understanding these causes can help in prevention and early detection:

• Ear infections: Particularly common in children, infections can cause fluid buildup behind the eardrum, increasing pressure until the membrane ruptures.
• Loud noises: Exposure to sudden, extremely loud sounds like explosions or gunshots can damage the eardrum.
• Rapid pressure changes: Activities such as flying, scuba diving, or driving in mountainous areas can cause rapid changes in ear pressure, potentially leading to eardrum rupture.
• Foreign objects: Inserting objects like cotton swabs too deeply into the ear canal can puncture the eardrum.
• Physical trauma: A powerful slap to the ear or any direct injury can cause the eardrum to rupture.

Recognizing the Symptoms of a Ruptured Eardrum

Identifying the signs of a ruptured eardrum is crucial for seeking timely medical attention. Common symptoms include:

• Sudden sharp pain in the ear that may quickly subside
• Drainage from the ear, which may be clear, bloody, or pus-like
• Partial or complete hearing loss in the affected ear
• Tinnitus or ringing in the ear
• Dizziness or vertigo
• Nausea or vomiting (in severe cases)

If you experience any of these symptoms, especially after exposure to the risk factors mentioned earlier, it’s important to consult a healthcare professional promptly.

Diagnostic Procedures for Eardrum Rupture

When a ruptured eardrum is suspected, healthcare providers employ various diagnostic methods to confirm the condition and assess its severity:

1. Otoscopy: This involves examining the ear canal and eardrum using an otoscope, a special instrument with a light and magnifying lens.
2. Tympanometry: This test measures the eardrum’s response to slight changes in air pressure, helping to evaluate its mobility and integrity.
3. Audiology tests: These assess the extent of hearing loss associated with the rupture.
4. Imaging studies: In some cases, CT scans or MRI may be used to visualize the structures of the middle and inner ear more clearly.

Early and accurate diagnosis is crucial for determining the appropriate treatment approach and preventing potential complications.

Treatment Options for a Ruptured Eardrum

The treatment for a ruptured eardrum depends on the severity of the damage and the underlying cause. Here are some common approaches:

Conservative Management

In many cases, a ruptured eardrum will heal on its own within a few weeks to months. During this time, it’s important to:

• Keep the ear dry to prevent infection
• Avoid swimming and submerging the head underwater
• Use ear drops as prescribed by a doctor
• Avoid blowing the nose forcefully, as this can affect pressure in the ear

Medications

Depending on the cause and symptoms, a healthcare provider may prescribe:

• Antibiotics to prevent or treat infections
• Pain relievers to manage discomfort
• Antihistamines or decongestants if allergies or congestion are contributing factors

Surgical Interventions

In some cases, especially for large perforations or those that don’t heal on their own, surgical repair may be necessary. Procedures can include:

• Tympanoplasty: A surgical procedure to repair the eardrum using a graft
• Myringoplasty: A specific type of tympanoplasty focused on repairing the tympanic membrane
• Patching: A minimally invasive procedure where a patch is placed over the perforation to promote healing

Recovery and Healing Process

The healing time for a ruptured eardrum can vary depending on the size of the perforation and individual factors. On average, small perforations may heal within a few weeks, while larger ones can take several months.

During the recovery period, it’s crucial to follow your doctor’s instructions carefully. This may include:

• Keeping the ear dry during bathing or showering
• Avoiding air travel until cleared by your doctor
• Refraining from swimming or other water activities
• Attending follow-up appointments to monitor healing progress

Most people experience a full recovery of hearing once the eardrum has healed completely. However, in some cases, there may be residual hearing loss or other complications that require ongoing management.

Preventing Eardrum Rupture

While not all cases of eardrum rupture can be prevented, there are steps you can take to reduce your risk:

• Treat ear infections promptly to prevent pressure buildup
• Avoid inserting objects into your ears, including cotton swabs
• Use proper ear protection when exposed to loud noises
• Practice careful equalization techniques when experiencing pressure changes (e.g., during air travel or scuba diving)
• Seek medical attention for persistent ear pain or discomfort

By understanding the causes and taking preventive measures, you can significantly reduce your risk of experiencing a ruptured eardrum.

Long-Term Implications and Management

While most cases of ruptured eardrums heal without long-term consequences, some individuals may experience ongoing issues that require careful management:

Recurrent Perforations

Some people may be prone to repeated eardrum ruptures. In such cases, ongoing care and preventive measures are crucial. This may include:

• Regular check-ups with an ENT specialist
• Use of custom-fitted earplugs for water activities
• Prompt treatment of upper respiratory infections to prevent ear complications

Chronic Middle Ear Issues

In some instances, a ruptured eardrum can lead to chronic middle ear problems, such as:

• Persistent infections
• Formation of cholesteatoma (abnormal skin growth in the middle ear)
• Ongoing hearing difficulties

These conditions may require long-term management and potentially additional surgical interventions.

Hearing Rehabilitation

For individuals who experience lasting hearing loss due to eardrum damage, various rehabilitation options are available:

• Hearing aids
• Assistive listening devices
• Auditory training programs

Working closely with audiologists and ENT specialists can help in developing a personalized plan to address any persistent hearing issues.

Understanding the potential long-term implications of a ruptured eardrum emphasizes the importance of proper initial treatment and ongoing care. By staying vigilant and seeking appropriate medical attention, most individuals can minimize the risk of lasting complications and maintain optimal ear health.

Images – Department of Pediatrics – UW–Madison

Unless otherwise noted, all images are courtesy of David P. McCormick, M.D.

AOM Images

Hemorrhagic AOM	Bullous AOM
AOM with some cobblestoning with edema of tympanic membrane	Severe Bulging AOM
AOM mild bulging	AOM, hemorrhage, opacification, air/fluid levels
AOM with hemorrhagic bulla	AOM with cobblestoning
Massive bulla, AOM	Mild or full bulging, air bubble, erythema, AOM
Bullous AOM	Mild bulging, air/fluid levels, marked erythema, AOM vs. OME Uncertainty
AOM, severe bulging	Severe Bulging AOM
Bullous AOM, bulla	Full or mild bulging, erythema, opaque fluid, AOM vs. OME Uncertainty
Moderate bulging AOM	AOM, tube granulation
AOM, edematous membrane	Hemmorrhagic bulla AOM
Bullous AOM	Mild bulging, bubbles, opaque fluid, tympanosclerosis
Tube granulation, erythema, AOM	AOM*
AOM*	AOM diagram*

*images courtesy of ePROM¹

OME Images

*images courtesy of ePROM¹

Other Images

*images courtesy of ePROM¹

¹:Kaleida PH, Ploof DL, Kurs-Lasky M, Shaikh N, Colborn DK, Haralam MA, Ray S, Kearney D, Paradise JL, Hoberman A. Pediatrics. Mastering diagnostic skills: Enhancing Proficiency in Otitis Media, a model for diagnostic skills training. 2009 Oct;124(4):e714-20. doi: 10.1542/peds.2008-2838. Epub 2009 Sep 28.

Ruptured eardrum Information | Mount Sinai

Tympanic membrane perforation; Eardrum – ruptured or perforated; Perforated eardrum

A ruptured eardrum is an opening or hole in the eardrum. The eardrum is a thin piece of tissue that separates the outer and middle ear. Damage to the eardrum may harm hearing.

The ear consists of external, middle, and inner structures. The eardrum and the 3 tiny bones conduct sound from the eardrum to the cochlea.

The external structures of the ear may aid in diagnosing some conditions by the presence or absence of normal landmarks and abnormal features including earlobe creases, preauricular pits, and preauricular tags.

Mastoiditis is an infection of the bony air cells in the mastoid bone, located just behind the ear. It is rarely seen today because of the use of antibiotics to treat ear infections. This child has drainage from the ear and redness (erythema) behind the ear over the mastoid bone.

The tympanic membrane (eardrum) separates the outer ear from the middle ear. The membrane vibrates when sound waves strike it, beginning the process that converts the sound wave into a nerve impulse that travels to the brain.

Causes

Ear infections may cause a ruptured eardrum. This occurs more often in children. The infection causes pus or fluid to build up behind the eardrum. As the pressure increases, the eardrum may break open (rupture).

Damage to the eardrum can also occur from:

• A very loud noise close to the ear, such as a gunshot
• A rapid change in ear pressure, which may occur when flying, scuba diving, or driving in the mountains
• Foreign objects in the ear
• Injury to the ear (such as from a powerful slap or explosion)
• Inserting cotton-tipped swabs or small objects into the ears to clean them

Symptoms

Ear pain may suddenly decrease right after your eardrum ruptures.

After the rupture, you may have:

• Drainage from the ear (drainage may be clear, pus, or bloody)
• Ear noise/buzzing
• Earache or ear discomfort
• Hearing loss in the involved ear (hearing loss may not be total)
• Weakness of the face, or dizziness (in severe cases)

Exams and Tests

The health care provider will look in your ear with an instrument called an otoscope. Sometimes they will need to use a microscope for a better view. If the eardrum is ruptured, the doctor will see an opening in it. The bones of the middle ear may also be visible.

Pus draining from the ear may make it harder for the doctor to see the eardrum. If pus is present and blocking the view of the eardrum, the doctor may need to suction the ear to clear the pus.

Audiology testing can measure how much hearing has been lost.

Treatment

You can take steps at home to treat ear pain.

• Put warm compresses on the ear to help relieve discomfort.
• Use medicines such as ibuprofen or acetaminophen to ease pain.

Keep the ear clean and dry while it is healing.

• Place cotton balls in the ear while showering or shampooing to prevent water from entering the ear.
• Avoid swimming or putting your head underneath the water.

Your provider may prescribe antibiotics (oral or ear drops) to prevent or treat an infection.

Repair of the eardrum might be needed for larger holes or ruptures or if the eardrum does not heal on its own. This can be done either in the office or under anesthesia.

• Patch the eardrum with a piece of the person’s own tissue taken (called tympanoplasty). This procedure will usually take 30 minutes to 2 hours.
• Repair smaller holes in the eardrum by placing either gel or a special paper over the eardrum (called myringoplasty). This procedure will usually take 10 to 30 minutes.

Outlook (Prognosis)

The opening in the eardrum most often heals by itself within 2 months if it is a small hole.

Hearing loss will be short-term if the rupture heals completely.

Rarely, other problems may occur, such as:

• Long-term hearing loss
• Spread of infection to the bone behind the ear (mastoiditis)
• Long-term vertigo and dizziness
• Chronic ear infection or ear drainage

When to Contact a Medical Professional

If your pain and symptoms improve after your eardrum ruptures, you may wait until the next day to see your provider.

Contact your provider right away after your eardrum ruptures if you:

• Are very dizzy
• Have a fever, general ill feeling, or hearing loss
• Have very bad pain or a loud ringing in your ear
• Have an object in your ear that does not come out
• Have any symptoms that last longer than 2 months after treatment

Prevention

DO NOT insert objects into the ear canal, even to clean it. Objects stuck in the ear should only be removed by a provider. Have ear infections treated right away.

Kerschner JE, Preciado D. Otitis media. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 658.

Pelton SI. Otitis externa, otitis media, and mastoiditis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 61.

Shaikh N. Otitis media. In: Long SS, Prober CG, Fischer M, Kimberlin DW, eds. Principles and Practice of Pediatric Infectious Diseases. 6th ed. Philadelphia, PA: Elsevier; 2023:chap 29.

Last reviewed on: 5/30/2022

Reviewed by: Josef Shargorodsky, MD, MPH, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Perforation of the tympanic membrane – causes and treatment

Contents

• Features of the structure and function
• Causes of damage to the tympanic membrane
• Diagnosis
• Consequences
• Treatment
• Preventive measures

Tympanic membrane rupture is a very painful and dangerous process. It can occur under a variety of circumstances and have serious consequences if not adequately treated and controlled.

What is eardrum perforation? What factors can affect its rupture? What are the symptoms of a perforated eardrum and how is it treated?

Contents

Features of the structure and function

The tympanic membrane is a functional septum between the outer and middle ear. It is used for:

• Protection of the middle section of the auditory organ against the penetration of bacteria and fungi;
• receiving and transmitting sound vibrations to the auditory ossicles in the tympanic cavity.

The tympanic membrane is a pearl gray movable membrane. In children, it has a round shape, as it grows older, it stretches into an oval. The size of the membrane is relatively small – its diameter is on average 1 cm, and the thickness does not exceed 0.1 mm.

The tympanic membrane consists of functional layers. The outer shell of the membrane is thinly covered with the epidermis, and the inner shell, located on the side of the middle part of the ear, is lined with mucous. Between these layers is fibrous tissue – low elasticity and prone to tearing.

When the membrane is perforated, the fibrous layer ruptures, but over time, the outer epidermis and mucosa fuse the tympanic membrane, forming dense scars with their overgrown cells.

Specialists identify two functional areas in the membrane:

1. The stretched part is located along the contour of the tympanic membrane in the places of its fusion with the cartilaginous tissue. She is constantly stressed.
2. The loose part extends from the temporal bone to the center of the membrane. There is no fibrous layer here, so the film is relaxed and responds well to sound vibrations.

Causes of damage to the tympanic membrane

Depending on what circumstances and diseases led to the rupture of the movable membrane, the signs of damage to the tympanic membrane will also differ.

See also: Meniere’s disease: symptoms, features and treatment

Acute otitis media

The most common cause of tympanic membrane rupture is purulent otitis media, in which exudate accumulates behind the membrane, produced during the inflammatory process, presses on it and causes its perforation.

Symptoms of suppurative otitis media increase as the disease progresses.

1. At the first stage, the patient experiences pain associated with the formation and gradual accumulation of exudate. Pus also causes changes in the eardrum – it turns red and begins to bulge outward.
2. In the second stage, the tympanic membrane ruptures under the pressure of pus accumulated in the middle ear. After that, the painful symptoms go away, and the exudate gradually flows out of the ear canal.
3. At the next stage after damage to the tympanic membrane, the signs of pathology and the inflammatory process gradually subside, and the membrane, as a rule, is completely scarred within 5-6 weeks.

Chronic suppurative otitis media

This form of suppurative otitis media is characterized by constant relapses of the disease, in which the tympanic membrane regularly ruptures. The inflammatory process affects large areas of the inner part of the ear, including the mucous membrane that covers the functional membrane, and the cartilaginous tissue to which it is attached.

In the chronic form of otitis, there are regular, sometimes not passing at all, purulent discharge from the ear, the quality of hearing is noticeably reduced, extraneous noises appear. Pain syndrome is noted in the acute phase. With this form, the rupture of the eardrum sometimes does not have time to scar, and the membrane itself is gradually destroyed under the influence of the inflammatory process.

Aerootitis

This pathology occurs, as a rule, with poor patency of the auditory tube. During an airplane flight, when there is a strong difference in pressure, the ENT system is not able to equalize it properly. The tympanic membrane during takeoff or landing is sharply drawn inward, and its breakthrough occurs.

Initially, the patient has a sensation of ear congestion, noise and ringing, and with direct perforation of the tympanic membrane, the symptoms will be as follows:

• Acute pain syndrome appears;
• sulphurous-bloody discharge begins to flow from the affected organ of hearing.

See also: Which doctor treats ears – who is a specialist in ear diseases

Direct injuries

Sometimes the patients themselves are to blame for the bursting of their eardrum. Its perforation can occur mechanically when cleaning the ears with accessories and objects that are not intended for this. Too deep insertion of matches, cotton buds into the ear canal can damage the eardrum. Also pushing thick sulfur masses inward can lead to its rupture.

The symptoms of tympanic membrane rupture during mechanical damage are similar to aerootitis – the patient feels a sharp pain, and then blood mixed with sulfur comes out of the ear.

Acoustic injury

Perforation can occur not only due to pressure drops, but also under the influence of loud sounds, although, in fact, in the second case, the injury is caused by an increase in air pressure on the eardrum.

Proximity to a source of loud sound (professional sound equipment, exploding projectiles, alarm systems) often causes damage to the eardrum – it cannot withstand air pressure and bursts. The patient experiences severe pain, ringing in the ears and temporarily loses hearing.

Fracture of the skull base

Traumatic brain injuries can also lead to perforation of the membrane if the destruction of the bones passes through the junctions with the cartilage tissue. In this case, the patient has blood flowing from the ear canal, sometimes mixed with cerebrospinal fluid.

Diagnosis

At the first symptoms of membrane perforation, you should consult a specialist – an otolaryngologist or a traumatologist, depending on the root cause of its rupture.

The doctor will use special instruments to examine the ear canal, evaluate the condition of the membrane, and make sure that there is a rupture.

If the patient’s ear leaks, the fluid will be analyzed to determine its nature and source.

Consequences

A visit to the doctor after a ruptured eardrum is essential. Its healing should take place under the supervision of a specialist. In addition, the perforated site will open the middle ear cavity to pathogenic flora, so supportive protective therapy is required. For any reason for perforation of the eardrum, the treatment will be complex and lengthy.

See also: Pain in the ear when swallowing on one side – causes and treatment for a child and an adult

chronic form.

Perforation of the tympanic membrane is not always able to heal on its own – this requires monitoring the course of its scarring in dynamics. If the hole does not close naturally in time, surgery is indicated for patients.

Treatment

1. An otolaryngologist will prescribe antibiotics to treat a bacterial infection.
2. If the tympanic membrane is severely injured, the doctor may make a patch at the site of the rupture. He will gently clean the blood clots and dirt from the surface of the membrane, treat the edges of the perforation with a special growth-stimulating compound, and put a shred on it.
3. Caustics such as chromic acid and silver nitrate are sometimes used to close the tear. They treat the injured edges of the membrane.
4. If the perforation is extensive or the hole in the membrane does not heal for a long time, the doctor will decide on the need for myringoplasty. Under general anesthesia, the patient’s own piece of skin is taken from the patient, then this obtained fragment is sewn with absorbable suture material to the membrane.

Preventive measures

To avoid tympanic membrane rupture and prolonged fusion of its tissues, certain preventive measures should be observed:

• Clean the ear canal only at the exit;
• avoid noisy places;
• Wear ear protectors during landing and takeoff;
• if there are no headphones on the plane, sucking up the lozenges helps to avoid the negative effects of pressure drops;
• start the treatment of otitis in a timely manner and bring it to the end, according to the recommendations of Laura.

Tympanic membrane injury, causes and symptoms

Treatment of tympanic membrane injuries in the ENT clinic №1.

Article rating

3.78 (Voted: 9)

Contents

• Causes of eardrum injury:

• Symptoms of eardrum injury:

• What to do:

Tympanic membrane injury is a condition in which the integrity of the eardrum is broken and a hole is formed in it – perforation. Sometimes perforation does not occur, but a hematoma forms in the area of ​​the tympanic membrane and (or) the external auditory canal due to vascular injury.

Causes of injury to the eardrum:

• mechanical damage – in case of careless toileting of the external auditory canal or an attempt to scratch the ear with cotton swabs or other sharp objects.
• a sharp increase in pressure in the external auditory canal – when diving into the water, when hitting the ear, sometimes just a slap on the auricle with the palm of your hand can cause a rupture of the eardrum.

Tympanic membrane injury symptoms:

• Acute pain in the ear, can go away fairly quickly.
• Noise in the ear, unpleasant sound sensation, lasts longer, up to 2 weeks, until the healing process begins.
• Hearing loss continues until the perforation is completely healed.

What to do:

If you have the above symptoms, do not self-medicate, but immediately contact a specialized ENT clinic or ENT room with a mandatory video endoscopic examination. During such an examination, an otorhinolaryngologist using a video camera with additional lighting, magnification and display on the screen will examine the eardrum and determine its integrity or the presence of perforation, which cannot be done during a normal examination.

As a rule, perforations heal on their own, approximately within a month, and a scar remains on the membrane. With significant trauma, the perforation may remain.

In the “ENT clinic plus 1” they will diagnose using video endoscopy of the ENT organs, provide the necessary assistance: stop the pain syndrome, prescribe an effective treatment.