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A ruptured or perforated eardrum is exactly what you might imagine: a tear or hole in the eardrum — the part of the ear that vibrates in response to sound waves. Eardrum injuries can be extremely painful and, in the worst cases, might lead to infections and hearing loss.

Fortunately, though, most eardrum injuries heal within a few weeks with no problems. When an eardrum won't heal on its own, surgery may be needed to repair it and restore normal hearing.

How the Ear Works

The eardrum, also called the tympanic membrane, is the thin, cone-shaped piece of tissue that separates the outer ear from the middle ear. It's found at the end of the ear canal (the part that gets waxy).

The hearing process begins when the pinna (the part of the ear that's visible) funnels sound waves into the ear canal, where they hit the eardrum and make it vibrate. In the inner ear, these vibrations are converted into nerve impulses by the snail-shaped cochlea. These impulses then travel to the brain along the cochlear nerve, also known as the auditory nerve. The brain's auditory cortex receives these signals and interprets them as different sounds.

If the eardrum is perforated, it can hurt the eardrum's ability to vibrate correctly, leading to muffled or diminished hearing. Hearing loss is usually temporary and can vary in intensity based on the size and location of the injury.

Sometimes bacteria and other materials enter the middle ear through this opening and can cause an infection. Fortunately, this rarely leads to permanent hearing damage.

Causes

Many people don't know that cleaning their ears with cotton swabs is a major cause of eardrum injuries. That's because poking around in the ear canal too harshly can easily injure the eardrum's fragile tissue, especially in young children, who have very narrow ear canals. (Tip: To clean wax build-up in the ears, opt for a wet washcloth and gently wipe outside the ear canal.)

But eardrums can be injured in lots of other ways, including:

• Ear infections. An infection of the middle ear or inner ear (such as otitis media) can lead to pus or fluid buildup behind the eardrum, which can cause it to burst. This is a common cause of ruptured eardrums in children.
• High or low altitudes (barotrauma). Usually, the air pressure in the middle ear and the pressure in the environment are in balance. A sudden change in barometric pressure (such as during air travel, driving on a mountain road, or scuba diving) can be enough to rupture an eardrum.
• Loud noises (acoustic trauma). Although uncommon, loud noises (like an explosion) can sometimes produce sound waves that are strong enough to damage the eardrum. Any loud noise also can cause temporary or permanent hearing damage to the cochlea and lead to hearing loss.
• Foreign objects. Besides cotton swabs, hairpins and other small objects that kids can fit in the ear canal can cause injuries.
• Head trauma. A direct blow to the ear can cause a skull fracture or pressure that might tear the eardrum.

Symptoms

When a child injures an eardrum, the first symptom is usually ear pain, which can range from mild to severe and might increase for a time before suddenly decreasing.

Other symptoms of an injured eardrum include:

• drainage from the ear that can be clear, pus-filled, or bloody
• hearing loss that may be mild to severe
• ringing or buzzing in the ear (tinnitus)
• dizziness or vertigo that can cause nausea or vomiting

Diagnosis

If your child has symptoms of a ruptured or perforated eardrum, call a doctor right away. Most injuries will heal on their own, but you should ensure that any hearing loss is only temporary.

Also seek medical care right away if your child has severe symptoms, such as bloody discharge from the ear, extreme pain, total hearing loss in one ear, or dizziness that causes vomiting.

To check for ruptured or perforated eardrum, the doctor will examine your child's ear canal with a lighted tool called an otoscope. Sometimes the doctor will be able to see the tear in the eardrum, but other times fluid in the ear will block the view.

The doctor might order other tests to check for hearing loss, such as:

• audiology exams that measure how well someone hears sounds at different pitches and volumes
• tympanometry to measure the response of the eardrum to slight changes in air pressure

If there is fluid leaking from the ear, the doctor might send a sample for testing to see if there is an infection of the middle ear or inner ear.

Treatment

Usually, eardrum injuries heal on their own within a few weeks without any treatment. While the eardrum is healing, over-the-counter pain relievers can help ease any pain. Ask your doctor about which pain relievers are best for your child.

To help prevent infections or treat an existing infection, the doctor may prescribe antibiotics. These may be liquid or pills to be swallowed or ear drops. Never give your child over-the-counter ear drops unless your doctor recommends it. Some drops are not meant to be used if there is a hole in the eardrum because they can cause problems with the middle ear or cochlea.

To protect the eardrum while it heals, your doctor may advise keeping your child's ear dry. Tell your child to keep his or her head above water while swimming, and gently place a waterproof earplug or cotton ball coated with petroleum jelly in the ear when your child showers or bathes. Children also should not forcefully blow their noses until the eardrum is completely healed.

If a ruptured or perforated eardrum doesn't heal on its own within about 4 weeks, a child might need to see a pediatric otolaryngologist or ENT (ear, nose, and throat doctor). After an exam and hearing testing, the otolaryngologist or ENT may recommend an eardrum patch. During this procedure, a chemical is applied to the edges of the rupture to stimulate growth and healing, then a paper patch is placed over the area to protect it. This might have to be done a few times before the eardrum is fully healed.

If all other treatments fail, a specialist might perform a surgery known as a tympanoplasty. In this procedure, a small patch of a child's own tissue is grafted onto the affected eardrum to close the tear. This is a relatively simple surgery, and kids usually can leave the hospital the same day.

Prevention

In some cases, such as an accidental blow to the ear, it's impossible to prevent an eardrum injury. But other cases of eardrum perforation are entirely preventable.

Here are some ways you and your kids can reduce the odds of an injury:

• Get immediate medical treatment for your child as soon as you notice any signs of an ear infection.
• Never stick anything in your child's ears — like cotton swabs — and teach kids to do the same. Regular bathing should be enough to keep earwax at normal levels. If your child complains of ear discomfort and you see earwax in the ear, it's OK to wipe the outside of the ear with a washcloth.
  
  If earwax is causing pain, discomfort, or a problem with hearing, talk to your doctor about having the earwax removed in the office. If your child does get something stuck in the ear, have a health care provider remove it to avoid further damage to the ear.
• Kids with colds or sinus infections should avoid airplane travel if possible. When kids do fly, give them some gum to chew during takeoff and landing or make sure they know how 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 these times.
• Anyone who will be scuba diving should be properly certified and know how to equalize the pressure in the ears.