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ruptured or perforated eardrum

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Middle ear

A perforated eardrum is an eardrum with a hole in it.

What is going on in the body? 
The eardrum is the dividing line between the external and middle ears. The external ear is formed by the auricle, also called the pinna, and the external ear canal. The middle ear is the air-filled space behind the eardrum that contains the three small bones for hearing, which are known as the ossicles. The eardrum is an important barrier between the environment and the middle ear.

The eardrum, or tympanic membrane, is a three-layered structure. On its outer layer is a very thin layer of skin. Its inner layer is a thin layer of mucous membrane. The middle or fibrous layer is what provides most of the eardrum strength and rigidity. It prevents air or water from hurting the delicate membranes covering the oval and round window membranes. If these window membranes rupture from excessive force, temporary or permanent deafness or dizziness can result. The eardrum also protects the middle ear against non-sterile material, like contaminated water.

What are the signs and symptoms of the condition? 
Holes in the eardrum are usually caused by trauma or infection. If the rupture is the result of trauma, symptoms include:
  • an immediate decline in hearing
  • ringing in the ear, called tinnitus
  • bloody ear drainage

If the rupture is the result of an infection, symptoms include:
  • bloody ear drainage
  • intense pain
  • hearing loss. Sometimes the ear canal is full of debris or is swollen.

If the rupture is the result of tuberculosis, symptoms include:
  • watery, clear ear drainage
  • hearing loss
Once the drum ruptures, the pain lessens. The degree of the hearing loss depends on the size and location of the hole.

What are the causes and risks of the condition? 
Ruptured eardrums are usually caused by:
  • trauma and sports trauma
  • use of Q-tips
  • ear infections, especially if the infections are severe
  • tuberculosis
  • pressure equalisation due to tube placement
  • welding burns
  • changes in barometric pressure, caused by activities such as flying in a plane or scuba diving
  • previous ruptures or chronic eustachian tube dysfunction, which can cause the eardrum to thin
What can be done to prevent the condition? 
The best way to prevent the eardrum from rupturing is to:
  • treat acute ear infections right away with antibiotics
  • not stick anything in the ear like Q-tips that could cause trauma
  • avoid scuba diving when a person has an upper respiratory tract infection or active allergies
It is often impossible to prevent trauma to the ear.

How is the condition diagnosed? 
Most holes, but not all, can be seen during an examination. If it is a result of infection, there will be pulsating, infected-looking fluid. If it is from tuberculosis, there will be many small holes with watery drainage. If the rupture is from trauma, there will usually be blood in the middle ear, around the edges of the hole, and also in the external canal.

When there is a hole in the eardrum, applying air into the ear canal using an otoscope, a tool with a light, magnifying glass and air pump, will not make the eardrum move. That is a very important observation, especially if the hole cannot be seen.

For very small holes, a tympanogram may be useful. A tympanogram measures eardrum movement and ear canal volume.

A hearing test can help quantify the degree of the hearing loss. If there is dizziness, a hearing test can tell if there has been damage to the nerve portion of hearing.

What are the long-term effects of the condition? 
The main reason to repair an eardrum is to provide a safe ear. An unrepaired eardrum puts the middle and inner ear at risk for barometric pressure injury or damage from infections. Eardrum holes can affect hearing.

What are the treatments for the condition? 
When a hole in the eardrum is diagnosed, it is important to:
  • keep contaminated or soapy water out of the ear canal
  • avoid blowing the nose
  • avoid changes in elevation
Most ruptures caused by trauma, ear infections, and pressure equalisation tubes will heal on their own. But some ruptures may require surgery. Ruptures that cause the edges of the eardrum to be blown inward will heal if the edges are lifted outward and a paper patch is placed over the hole. Small ruptures will heal by removing the mature edge of the hole and covering it with a small piece of fat. For larger holes, tissue is usually taken from the chewing muscle located in the temple, called the temporalis muscle. This tissue is then placed under the eardrum or on its surface to act as a scaffold for the drum to heal over.

What are the side effects of the treatments or possible complications? 
The side effects of surgery include:
  • taste disturbance (usually temporary)
  • hearing loss
  • tinnitus
  • vertigo (giddiness) usually temporary
  • Facial nerve damage (very rare)
Sometimes surgery does not work. Also, people with holes in two layers of membrane have a higher failure rate after attempted repair.

What happens after treatment for the condition? 
If treatment is successful, the protective barrier effect of the eardrum is restored, and hearing recovers to a completely normal state.

How is the condition monitored? 
Hearing should improve as the hole closes. If this does not happen, there may be another rupture. Anyone with a known rupture who gets water in the middle ear, should use antibiotic eardrops to prevent an ear infection. A person who has continued or recurrent episodes of ear drainage may have a chronic ear infection. He or she should see a doctor for possible treatment.

Author: Mark Loury, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

This website and article is not a substitute for independent professional advice. Nothing contained in this website is intended to be used as medical advice and it is not intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional's advice.  All Health and any associated parties do not accept any liability for any injury, loss or damage incurred by use of or reliance on the information.

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