A perforated eardrum is a hole or rupture in the eardrum, a thin membrane that
separates the ear canal and the middle ear. The medical term for eardrum is tympanic
membrane. The middle ear is connected to the nose by the eustachian tube, which
equalizes pressure in the middle ear.
A perforated eardrum is often accompanied by decreased hearing and occasional
discharge. Pain is usually not persistent.
Causes of Eardrum Perforation
The causes of perforated eardrum are usually from trauma or infection. A perforated
eardrum can occur: If the ear is struck squarely with an open hand
With a skull fracture
After a sudden explosion
If an object (such as a bobby pin, Q-tip, or stick) is pushed too far into
the ear canal.
As a result of hot slag (from welding) or acid entering the ear canal
Middle ear infections may cause pain, hearing loss, and spontaneous rupture
(tear) of the ear-drum resulting in a perforation. In this circumstance, there
maybe infected or bloody drainage from the ear. In medical terms, this is called
otitis media with perforation.
On rare occasions a small hole may remain in the eardrum after a previously
placed PE tube (pressure equalizing) either falls out or is removed by the
Most eardrum perforations heal spontaneously within weeks after rupture, although
some may take up to several months. During the healing process the ear must
be protected from water and trauma. Those eardrum perforations which do not
heal on their own may require surgery.
Effects on Hearing from Perforated Eardrum
Usually, the larger the perforation, the greater the loss of hearing. The location
of the hole (perforation) in the eardrum also effects the degree of hearing
loss. If severe trauma (e.g. skull fracture) disrupts the bones in the middle
ear which transmit sound or causes injury to the inner ear structures, the
loss of hearing maybe quite severe.
If the perforated eardrum is due to a sudden traumatic or explosive event,
the loss of hearing can be great and ringing in the ear (tinnitus) may be severe.
In this case the hearing usually returns partially, and the ringing diminishes
in a few days. Chronic infection as a result of the perforation can cause major
Treatment of the Perforated Eardrum
Before attempting any correction of the perforation, a hearing test should
be performed. The benefits of closing a perforation include prevention of water
entering the ear while showering, bathing, or swimming (which could cause ear
infection), improved hearing, and diminished tinnitus. It also may prevent
the development of cholesteatoma (skin cyst in the middle ear), which can cause
chronic infection and destruction of ear structures.
If the perforation is very small, otolaryngologists may choose to observe
the perforation over time to see if it will dose spontaneously. They also might
try to patch a cooperative patient's ear-drum in the office. Working with a
microscope, your doctor may touch the edges of the eardrum with a chemical
to stimulate growth and then place a thin paper patch on the eardrum. Usually
with closure of the tympanic membrane improvement in hearing is noted. Several
applications of a patch (up to three or four) may be required before the perforation
doses completely. if your physician feels that a paper patch will not provide
prompt or adequate closure of the hole in the eardrum, or attempts with paper
patching do not promote healing, surgery is considered.
There are a variety of surgical techniques, but all basically place tissue
across the perforation allowing healing. The name of this procedure is called
tympanoplasty. Surgery is typically quite successful in closing the perforation
permanently, and improving hearing. It is usually done on an outpatient basis.
Your doctor will advise you regarding the proper management of a perforated
If you have further questions about Perforated Eardrums, please feel free
to contact our office.
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