|SSM Cardinal Glennon Children's Medical Center|
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 arising. When an eardrum won't heal on its own, surgery may be required 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 hinder 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.
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:
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:
If your child has symptoms of a ruptured or perforated eardrum (even after receiving treatment), 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 immediate medical care 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 instrument called an otoscope. Sometimes the doctor will be able to see the tear in the eardrum, but other times fluid draining from the ear will obscure the view.
The doctor might call for additional tests to check for hearing loss, such as:
If there is discharge 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.
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. Consult with 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 ear drops or pills to be taken by mouth. 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.
In cases where ruptured or perforated eardrums don't heal on their own, a pediatric otolaryngologist or ENT (ear, nose, and throat doctor) may recommend an eardrum patch for your child. 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 procedure might have to be done a number of 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.
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 steps you and your child can take to reduce the odds of an injury:
Reviewed by: Steven P. Cook, MD