A perforated eardrum is a tear or hole in the ear's tympanic membrane (the medical name for your eardrum). A perforated eardrum is also called a ruptured eardrum.
A perforated eardrum can cause a lot of pain. It can also affect hearing, but this usually is temporary.
A tear in the eardrum can allow bacteria and other things to get into the middle ear and inner ear. This could lead to an infection that might cause more permanent hearing damage.
Most perforated eardrums heal in a few days to weeks. If they don't heal, sometimes doctors do a surgery to repair the hole.
How Does the Eardrum Work?
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?
Things that can cause perforated eardrums include:
Cotton swabs or other cleaning tools. These can poke through the eardrum.
Sudden pressure changes (barotraumas). This might happen when flying in an airplane, driving on a mountain road, or scuba diving.
Loud noises (acoustic trauma). Really loud noises, like an explosion or listening to loud music, can make sound waves that are 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 accident 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 to build up behind the eardrum. This can make the eardrum burst.
What Are the Signs & Symptoms of a Perforated Eardrum?
The first sign of a perforated eardrum is usually pain, which may increase for a time before suddenly decreasing. Someone also might notice:
drainage from the ear that can be clear, pus-like, or bloody
ringing or buzzing in the ear (tinnitus)
dizziness or vertigo (a feeling that the room is spinning) that can cause nausea
weakness in the muscles of the face
Talk to a parent or call a doctor right away if you have any symptoms of a perforated eardrum. You should also see a doctor if you continue to have symptoms after being treated for a perforated eardrum. Even though most perforations heal on their own, you want to make sure any hearing loss you is temporary.
Go to the emergency room right away if you have severe symptoms, such as:
bloody discharge from your ear
total hearing loss in one ear
dizziness that causes vomiting
How Are Perforated Eardrums Diagnosed?
A doctor will most likely:
examine your ear canal with a lighted instrument called an otoscope
do an audiology exam to see how well you hear at difference pitches and volumes
take a sample of fluid from the ear to test for infection
How Are Perforated Eardrums Treated?
Usually, a perforated eardrum will heal on its own within a few weeks. While the eardrum is healing, your doctor might suggest:
taking over-the-counter pain relievers
using antibiotics to prevent infections or treat any existing infections (these could be given as a pill or as ear drops)
While your eardrum heals:
Don't use over-the-counter ear drops unless your doctor tells you to. If there is a hole in the eardrum, some kinds of ear drops can get into the middle ear or cochlea and cause problems.
Avoid getting water inside the ear canal. Your doctor might recommend that you keep your ear dry during water activities to prevent infection. Gently place a waterproof earplug or cotton ball coated with petroleum jelly in your ear when you shower or take a bath.
Don't clean your ear or forcefully blow your nose. Wait until the tear in your eardrum is completely healed.
If your eardrum doesn't heal on its own, an ear-nose-throat (ENT) specialist may recommend surgery to place an eardrum patch. The doctor puts a paper patch over the hole after applying a special medicine to make the tear heal. Doctors may need to do this procedure a few times until the eardrum is fully healed.
If the eardrum patch doesn't work, the ENT specialist might do a surgery known as a tympanoplasty. The surgeon will attach a small patch of your own tissue or use man-made material to cover the hole in your eardrum.
Can Perforated Eardrums Be Prevented?
Sometimes a perforated eardrum is caused by an infection and isn't preventable. But many eardrum perforations are preventable.
To make the chances of a rupture less likely:
Try to avoid flying on airplanes if you have a cold or sinus infection. If you have to fly, chew gum during takeoff and landing. You can also try to equalize the pressure in your ears by yawning or swallowing.
Get lessons if you plan to go scuba diving. Make sure you learn how to equalize the pressure in your ears. Don't scuba dive if you have an ear infection, sinus infection, or cold.
Never stick anything in your ear, even to clean it. If you get something stuck in your ear, see a health care provider to take it out, so you don't hurt your ear.
Call your doctor right away if you notice any signs of an ear infection.