Perforated Eardrum

A perforated eardrum, which results from a rupture of the tympanic membrane, may cause hearing loss.

Eardrum perforation caused by a loud noise may result in ringing in the ear ( tinnitus ), in addition to a temporary hearing loss. Over time, this hearing loss improves and the ringing usually fades in a few days.

Causes

The usual cause of a perforated eardrum is trauma: the deliberate or accidental insertion of a sharp object (such as a hair pin) or a sudden excessive change in pressure (from an explosion, a blow to the head, flying, or diving). The injury may also result from untreated otitis media and, in children, from acute otitis media.

Symptoms

Symptoms include an earache or pain in the ear, which may be severe, or a sudden decrease in ear pain, followed by ear drainage of clear, bloody, or pus-filled fluid, hearing loss, or ear noise/buzzing.

Diagnostic tests

Andiometric testing allows evaluation of middle ear function.

Culture of the drainage can identify a causative organism, if infection caused the rupture. X-rays of the temporal lobe and skull are used to determine if there is an associated fracture, especially when a bad fall causes the perforation.

Treatment

Most eardrum perforations heal spontaneously in a few weeks. If any crust remains on the tympanic membrane after 2 weeks, an ear specialist removes it under magnification to see if healing is complete. If necessary, treatment includes local and systemic antibiotic therapy and analgesics for pain.

A large perforation with uncontrolled bleeding may require immediate surgery to approximate the ruptured edges. If the patient needs surgical closure, he may undergo a myringoplasty or tympanoplasty.

Prevention

Do not insert objects into the ear canal, even to clean it. Foreign objects should only be removed by a health care provider. Have ear infections treated promptly.

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