An eardrum perforation is a hole or tear in the thin membrane that separates the outer ear canal from the middle ear. An eardrum perforation can occur following an ear infection, injury, sudden pressure change or exposure to a very loud noise.
Many perforations heal naturally over time, while others may require monitoring, medical treatment or referral for further assessment. This article explains what an eardrum perforation is, common symptoms and causes, how it is assessed, and the treatment options that may be considered.
What is an eardrum perforation?
The eardrum, also known as the tympanic membrane, is a thin structure at the end of the ear canal. It separates the outer ear from the middle ear and plays an important role in hearing by vibrating in response to sound.
An eardrum perforation occurs when a hole or tear develops in the eardrum.
The size and position of the perforation can vary. The effect on hearing can also vary depending on the size and location of the perforation and whether other structures within the middle ear have been affected.
Some people have noticeable symptoms, while others may have relatively few symptoms.
Many eardrum perforations heal without surgery, often over several weeks. However, healing time varies between individuals.
What are the symptoms of an eardrum perforation?
Symptoms may vary between individuals and can depend on what caused the perforation.
Possible symptoms include:
- Reduced or muffled hearing
- Ear pain or discomfort
- Ringing or buzzing in the ear (tinnitus)
- Fluid, pus or blood coming from the ear
- A feeling of pressure or fullness
- Dizziness or a spinning sensation
- A sudden change in hearing following an injury, loud noise or pressure change
Some people may have a perforation without significant symptoms.
It is important to remember that these symptoms can also occur with other ear conditions. An examination is therefore needed to determine the likely cause.
What causes an eardrum perforation?
An eardrum perforation can have a number of causes.
Middle ear infection
A middle ear infection can cause fluid and pressure to build up behind the eardrum. In some cases, the pressure can result in the eardrum bursting, allowing fluid or infected material to drain into the ear canal.
Injury to the ear
The eardrum can be injured by objects placed into the ear canal, such as cotton buds or hair pins. A direct blow to the ear or head from say a sporting injury can also cause a perforation.
Changes in air pressure
Rapid changes in pressure can occasionally cause an eardrum perforation. This may occur with activities such as flying or scuba diving, particularly where there is a significant difference in pressure across the eardrum.
Loud noise
Very loud sounds, including explosions or other high-intensity noise, can damage the eardrum and cause a perforation.
Previous ear surgery or grommets
A previous procedure involving the eardrum, including the insertion of a grommet, can leave a small opening in the eardrum. Although it is a hole in the eardrum, it is not caused an accidental injury, but a controlled surgical treatment. After grommets come out, they generally heal on their own.
When should you seek professional care?
If you think you may have an eardrum perforation, an examination can help determine what is happening and whether further assessment is appropriate.
You should consider seeking medical assessment if you have:
- A sudden change or reduction in hearing
- Ear discharge, particularly if it contains blood or pus
- Persistent ear pain
- Dizziness or balance symptoms
- Symptoms following an injury, loud noise or significant pressure change
- An eardrum perforation that has not healed as expected
Sudden hearing loss, particularly when accompanied by dizziness or other significant symptoms, should be assessed promptly because there are several possible causes of sudden hearing changes.
How is an eardrum perforation treated?
Treatment depends on the cause, size and location of the perforation, symptoms, whether infection is present and whether the perforation is healing.
Observation and keeping the ear dry
Many eardrum perforations heal naturally without surgery. During the healing period, keeping water out of the ear is always recommended. Swimming may need to be avoided until the eardrum has healed. This is so that middle ear infections do not occur.
Medication
If an infection is present, a doctor may prescribe appropriate medication. Not all ear drops are suitable when there is a perforated eardrum, so it is important to obtain appropriate medical advice before putting any kind of drop or product into the ear.
Microsuction and ear cleaning
Microsuction is commonly used to remove earwax, debris or discharge from the ear canal when clinically appropriate.
When an eardrum perforation is known or suspected, the ear should be assessed carefully before any ear-cleaning procedure is undertaken. The presence of a perforation can affect which cleaning techniques and products are appropriate.
Microsuction does not repair the perforation itself. Its role, where appropriate, is to assist with assessment or removal of material from the ear canal.
Surgical repair
Some perforations do not close naturally. If a perforation persists, or if there are associated hearing or middle-ear concerns, medical or ENT assessment may be recommended.
A surgical procedure such as a myringoplasty may be considered to repair the hole in the eardrum. Whether surgery is appropriate depends on the individual circumstances.
What to expect at an appointment for an eardrum perforation
An ear assessment generally begins with a discussion about your symptoms and relevant history. This may include questions about:
- When the hearing change or other symptoms began
- Previous ear infections
- Previous ear surgery or grommets
- Recent flying, diving or other pressure changes
- Injury to the ear
- Exposure to loud noise
- Ear discharge or bleeding
- Previous treatment or ear drops
The ear canal and eardrum can then be examined using appropriate equipment.
Wax, debris or discharge can sometimes make it difficult to see the eardrum clearly. If material is present, removal may be considered where appropriate so that the canal and eardrum can be assessed.
Depending on the findings, you may be advised to see your GP, audiologist or an ENT doctor for further assessment.
Multiple appointments may sometimes be required, particularly when monitoring healing or when the initial examination is limited by inflammation, discharge or debris.
Important considerations
An eardrum perforation is not the only possible explanation for hearing loss, ear discharge, pain or tinnitus.
Other conditions can produce similar symptoms, including ear infections, ear canal inflammation, Eustachian tube problems, earwax, middle-ear conditions and other causes of hearing loss.
The appearance of the eardrum also needs to be considered in context. A small hole, a healing perforation, scarring or other changes to the tympanic membrane may have different clinical implications. Sometimes referral to another healthcare professional is required.
Individual outcomes vary, and the appropriate management will depend on the findings at assessment.
About The Ear Nurses at Crystal Clear Ears
The Ear Nurses at Crystal Clear Ears provide ear care in Melbourne, including assessment and earwax removal services.
Care is provided by registered nurses trained in aural care. Nurses assess the ear canal and eardrum within their scope of practice and consider the individual’s history and clinical presentation.
Where earwax, debris or discharge needs to be removed, equipment such as an operating microscope and microsuction equipment may be used where appropriate.
An eardrum perforation does not automatically mean that ear cleaning cannot be performed. However, the presence, size, location and condition of the perforation, along with the overall presentation of the ear will be considered and managed appropriately.
If you think you have an eardrum perforation
If you have noticed a change in your hearing, ear discharge or other symptoms that may indicate an eardrum perforation, you may wish to arrange an assessment with The Ear Nurses at Crystal Clear Ears. You can contact the clinic to discuss whether an ear assessment is appropriate for your circumstances.
Frequently Asked Questions
Yes. Many eardrum perforations heal naturally over several weeks. The time required varies depending on factors such as the cause and characteristics of the perforation. Some perforations persist and may require further medical or ENT assessment.
Yes, microsuction is commonly used for removing material from the ear canal, but whether it is appropriate depends on the individual ear and clinical findings. A perforated eardrum should be assessed before deciding whether ear cleaning is appropriate.
Some ear drops are not suitable when there is a perforation because medication can potentially pass through the opening into the middle ear. Do not use ear drops unless they have been recommended as appropriate for your circumstances by a healthcare professional.
Keeping the ear dry while a perforation is healing is generally recommended, and swimming may need to be avoided during this period. Your healthcare professional can advise you based on the condition of your ear.
It can. Hearing changes can occur with an eardrum perforation, although the degree of hearing change varies. The effect can depend on the size and position of the perforation and whether other parts of the middle ear are involved.
Medical information: This article provides general educational information and is not intended to diagnose or treat an individual condition. If you have concerns about your ears or hearing, seek assessment from an appropriately qualified healthcare professional.