Eardrum Injuries

What Is a Perforated Eardrum?

A perforated eardrum is a tear or hole in the ear's tympanic membrane (the eardrum). A perforated eardrum is also called a ruptured eardrum.

A perforated (PER-fer-ate-id) eardrum can hurt, but most heal in a few days to weeks. If they don't heal, sometimes doctors do a surgery to fix the hole.

What Does the Eardrum Do?

The eardrum is a thin piece of skin-like tissue that's stretched tight — like a drum — across the opening between the ear canal and the middle ear.

The outer ear funnels sound waves into the ear canal that hit the eardrum and make it vibrate. The middle ear and inner ear change the vibrations to signals that the brain senses as sounds.

A ruptured eardrum can't vibrate as well as it should. This can cause a hearing problem, which often is temporary.

What Causes a Perforated Eardrum?

Many things can tear an eardrum, such as:

• Using cotton swabs. Sticking anything into the ears raises the risk of infection or damage to the ear canal or eardrum. Cotton swabs are handy for grooming needs, but should not be used to clean the ears or remove earwax.
• Sudden pressure changes (barotraumas). Most of the time, the air pressure in the middle ear and the pressure in the environment are in balance. But things like flying in an airplane, driving on a mountain road, or scuba diving can cause a sudden change in pressure that can rupture an eardrum.
• Loud noises (acoustic trauma). Very loud noises, like an explosion, can create sound waves strong enough to damage the eardrum. Loud noise also can cause temporary or permanent damage to the cochlea.
• Head trauma. A direct blow to the ear or a severe head injury from something like a car crash can fracture (break) the skull bone and tear the eardrum.
• Direct trauma to the pinna and outer ear canal. A slap on the ear with an open hand or other things that put pressure on the ear can tear the eardrum.
• Ear infections. An infection of the middle ear or inner ear can cause pus or fluid buildup behind the eardrum. This can make the eardrum burst open.

What Are the Signs & Symptoms of a Perforated Eardrum?

The typical first sign of a perforated eardrum is pain. A child might have:

• mild to severe pain that may get worse for a time before suddenly decreasing
• drainage from the ear that can be clear, pus-filled, or bloody
• hearing loss
• ringing or buzzing in the ear (tinnitus)
• dizziness or vertigo (a feeling that the room is spinning)
• rarely, weak facial muscles

Call the doctor right away if your child has any symptoms of a perforated eardrum. Even though most perforations heal on their own, it's important to make sure any hearing loss is temporary.

Go to the emergency room right away if your child has:

• bloody discharge from the ear
• extreme pain
• total hearing loss in one ear
• dizziness that causes vomiting

How Is a Perforated Eardrum Diagnosed?

To check for a perforated eardrum, doctors check the ear canal with a lighted instrument called an otoscope. Often, a doctor can see the tear and sometimes the tiny bones of the middle ear. In some cases, fluid draining from the ear can make it hard to see the eardrum.

The doctor also might:

• order an audiology exam to measure how well the child hears at different pitches and volumes
• order a tympanometry to measure the response of the eardrum to slight changes in air pressure
• send a sample of fluid draining from the ear to a lab to check for infection

How Is a Perforated Eardrum Treated?

Most perforated eardrums heal on their own in a few weeks without treatment. Over-the-counter pain relievers can help ease pain.

To help prevent or treat an infection, the doctor may prescribe antibiotics. These might be a pill that your child swallows, but sometimes can be ear drops.

If the eardrum doesn't heal on its own in a few weeks, an ear-nose-throat (ENT) specialist may recommend an eardrum patch. In this procedure, a doctor puts a paper patch over the hole. Doctors may need to do this a few times until the eardrum fully heals.

If these treatments don't work, the ENT specialist might recommend a tympanoplasty. In this surgery, the surgeon attaches a small patch of the patient's own tissue or a man-made material to close the eardrum tear.

What Else Should I Know?

While recovering from a perforated eardrum, kids should:

1. Never use over-the-counter ear drops unless the doctor says to. With a hole in the eardrum, some kinds of ear drops can get into the middle ear or cochlea and cause problems.
2. Try to keep the ear canal dry. The doctor might recommend keeping the ear dry to prevent infection. Gently place a waterproof earplug or cotton ball coated with petroleum jelly in the ear when your child showers or takes a bath.
3. Take care when blowing their nose. Doing so with force can cause pain and more injury to the eardrum.

Can Perforated Eardrums Be Prevented?

You can't prevent all perforated eardrums, such as those caused by an infection. But some are avoidable.

To help prevent a rupture:

• Call the doctor right away if your child has signs of an ear infection.
• Never stick anything into the ears, even to clean them. If something stuck gets in your child's ear, have it removed by a health care provider. Trying to do it at home could damage the ear.
• Avoid flying on airplanes if your child has a cold or sinus infection. If you have to fly, have kids chew some gum during takeoff and landing. They also can try to equalize the pressure in their ears by yawning or swallowing. Babies should be breastfed or given a bottle or sippy cup to drink during takeoff and landing.
• Get lessons before scuba diving. These teach kids how to equalize the pressure in their ears. They shouldn't scuba dive if they have an ear infection, sinus infection, or cold.