A ruptured eardrum refers to a tear or hole in the eardrum (tympanic membrane) of the ear.
A ruptured eardrum, also known as a perforated eardrum or tympanic membrane perforation, refers to a tear or hole in the eardrum (tympanic membrane) of the ear. The eardrum is a thin membrane separating the ear canal from the middle ear. Its role is to enable hearing by responding to the vibration of sound waves and converting them into neural impulses for interpretation by the brain. The other role of the tympanic membrane is to guard the middle ear from external contaminants, including water, bacteria, or other substances.
What Causes a Ruptured Eardrum?
A perforation to the eardrum can be as a result from a number of causes. These include:
- Infection of the middle ear (otitis media). This may cause a build-up of fluid and pressure within the middle ear. In some cases, the pressure may accumulate so much that it causes the tympanic membrane to burst.
- Acoustic trauma. This refers to sudden and excessively loud noise causing the eardrum to pop, though such situations are less common. Examples of acoustic trauma include gunshots, explosions, or blasting loud music.
- Barotrauma is the term given to injury caused by pressure. A significant imbalance in pressure between the middle ear and the external environment can cause the eardrum to rupture. Instances of barotrauma can be associated with deep sea scuba divers but, more commonly, air travel.
- Physical injury to the ear from foreign objects. This scenario may be more common in children with a tendency to insert sharp objects such as pencils into their ear canals. However, a torn eardrum can also occur when trying to clean the ear with cotton buds or hairpins.
- Head trauma. Head trauma, whether a sharp slap to the ear or a skull fracture can cause damage to the structures of the inner and middle ear, including the eardrum.
Symptoms of a Ruptured Eardrum
In most cases you’re likely to realize something is amiss with your ear and/or hearing. However, it is also possible to be unaware that there’s been any injury to your eardrum.
A popped eardrum can be associated with either a sudden sharp pain in the ear or, counterintuitively, a sudden relief of pain in the ear, especially if you had been experiencing discomfort from a middle ear infection. Release of the pressure and pus build-up from rupturing the membrane can make the pain of a middle ear infection improve.
You may notice some leakage of fluid from the ear canal, which can be pus-like, blood-tinged, or simply clear fluid.
Given the important role of the eardrum for hearing, you may be aware of some degree of hearing loss in the affected ear. This hearing impairment can range from a mild muffling of sounds to full hearing loss. Some people also report experiencing tinnitus, which is a ringing, buzzing, clicking, roaring, or other description of noise, heard in the ear with no external source.
With the barrier between the external environment and the middle ear now compromised, eardrum perforations can be associated with recurrent ear infections, though there can also be other causes of episodic ear infections.
Some people with a ruptured eardrum may report vertigo (dizziness) and nausea or vomiting associated with the vertigo. High temperatures and a fever may also be associated with tympanic membrane perforation.
Management of a Ruptured Eardrum
The diagnosis of a torn eardrum can be made with an ENT (ear, nose, throat) specialist having a quick peek at the eardrum with an instrument known as an otoscope. You may also undergo other tests to assess the exact cause or extent of your hearing loss or to diagnose a middle ear infection.
In terms of treatment, the majority of ruptured eardrums will self-resolve completely within a matter of two to three months. In the meantime, you may be prescribed antibiotics, whether topical ear drops or an oral tablet, to either treat an existing infection or to prevent one from developing while the membrane heals.
While your eardrum heals, it’s important to:
- Avoid getting water into the ear while showering or bathing by using waterproof earplugs; you will likely need to avoid swimming altogether until given the all-clear by your doctor
- Avoid inserting any objects into the ear in an attempt to clear out earwax
- Avoid blowing your nose as the pressure can exacerbate the damage to the eardrum and slow its healing
- Avoid using any other ear drop medications unless approved by your doctor
If you’re bothered by ear pain or earache, your doctor may recommend taking a painkiller such as ibuprofen or acetaminophen.
For eardrum perforations which take too long to heal, your ENT specialist may recommend an intervention, such as an eardrum patch or surgery.
An eardrum patch, also known as myringoplasty, involves adhering a patch of material over the perforation. The patch made by created by a gel or a paper-like tissue and can be done under local anesthetic in the doctor’s office.
If myringoplasty is deemed to be inappropriate, or if it was tried unsuccessfully, you may be recommended surgery with a tympanoplasty procedure. Situations where surgery is more likely to be necessary include large tears in the eardrum, if the tear involves the edge of the eardrum, or if there’s a chronic ear infection unable to be successfully treated with antibiotics. A tympanoplasty typically takes two to three hours, performed as a day procedure under general anesthesia. A small section of tissue is taken from a vein or muscle sheath and grafted over the tear in the eardrum.
Preventing a Ruptured Eardrum
Though most cases of a ruptured eardrum heal without complications, it’s best to avoid one in the first place. Consider:
- Avoiding inserting foreign objects into the ear, even if to try and clean out excess earwax. There are other, safer methods of dealing with what’s known as cerumen impaction.
- Learn how to equalize the pressure in your ears during air travel. There are a number of methods to unblock your ears when the airplane takes off or lands, such as yawning or chewing gum. Also, if possible, avoid flying if you know you already have issues with pressure and congestion in your ears, such as during a cold or allergy.
- Wear ear protection in environments where you expect loud noises. On the shooting range or in demolition sites, hearing protection should always be used.
- Treat middle ear infections promptly by seeing your family doctor if you suspect an ear infection. Symptoms can include hearing loss, earache, and fever.
Fortunately, tympanic membrane perforations are not overly common with a prevalence of around 2.1% in the US. Being able to identify a potential ruptured eardrum and seek assessment with a doctor can help you to ensure your ear and hearing can heal without complications.