Perforated eardrum

Page last reviewed: 13/07/2011

A perforated eardrum is a hole or tear in the eardrum. It may be uncomfortable but usually heals on its own without treatment within two months.

The eardrum, also known as the tympanic membrane, is a thin layer of tissue that separates the outer ear from the middle ear.

If you have a perforated eardrum, your hearing will probably be affected and you will have earache. Any hearing loss is usually temporary. Read more about the symptoms of a perforated eardrum.

There are several possible causes of a perforated eardrum. The most common cause is an infection of the middle ear. It can also be caused by a loud noise or injury to the ear.

If you have a perforated eardrum, avoid getting your ear wet and take painkillers as required. Surgery may be necessary in severe cases. Read more about treating a perforated eardrum.

When to get medical help

See your GP if you have pain or discomfort in your ear for more than a couple of days.

The ear

The ear consists of three parts:

  • the outer ear
  • the middle ear
  • the inner ear

The outer ear is made up of the visible part of the ear (pinna) on the side of your head, the ear canal that goes into your head, and the eardrum.

The middle ear is a small, air-filled cavity, connected to the nose and throat by the eustachian tube. Inside the middle ear there are three small bones, known as the ossicles.

The inner ear is made up of:

  • a coiled, spiral tube (the cochlea) that contains two fluid-filled chambers
  • a nerve that transmits sounds to the brain (auditory nerve)

What does the eardrum do?

The eardrum helps you to hear. Sound waves enter the ear and make the eardrum vibrate. The vibrations from the eardrum pass through the small bones (ossicles) inside the middle ear. The ossicles amplify the vibrations and pass them on to the inner ear.

The cochlea in the inner ear contains tiny hair cells that move in response to the vibrations passed from the middle ear. The movement of the hair cells generates an electrical signal that is transmitted to the brain along the auditory nerve.

Page last reviewed: 13/07/2011

If you have a perforated eardrum, your hearing may be affected.

The extent of any hearing loss will depend on the size of the hole in your eardrum. A small puncture may only cause a slight loss of hearing, whereas a large puncture is likely to cause greater hearing loss.

The hearing loss is only temporary and your hearing will return once your eardrum has healed.

As well as hearing loss, a perforated eardrum may cause the following symptoms:

  • earache or discomfort
  • a discharge of mucus from your ear
  • ringing or buzzing in your ear (tinnitus)

Risk of infection

The eardrum forms a protective barrier that prevents germs and bacteria from entering your middle ear. Therefore, if you have a perforated eardrum, your risk of developing an ear infection is increased.

If you have an infection of the middle ear, your symptoms may include:

  • severe earache, due to the pressure of the mucus on the eardrum
  • a high temperature (fever) of 38C (100.4F) or above
  • slight hearing loss

Spotting an ear infection in children

Children who have an ear infection may also develop flu-like symptoms, such as vomiting and a lack of energy. Babies with ear infections will be hot and irritable.

Other signs of an ear infection in children and babies are:

  • pulling, tugging or rubbing their ear
  • a high temperature (38C or above)
  • irritability
  • poor feeding
  • restlessness at night
  • coughing
  • runny nose
  • not responding to quiet sounds
  • loss of balance
Discharge
Discharge is when a liquid, such as pus, oozes from a part of your body.

Page last reviewed: 13/07/2011

A perforated eardrum can have several different causes.

Middle ear infection

An infection of the middle ear is one of the most common causes of a perforated eardrum. If you have an ear infection, pus can build up inside your ear and put pressure on your eardrum.

Sometimes, the amount of pus in your ear can build up so much that the eardrum bursts, allowing the pus to escape. This mucus discharge is a common symptom of a perforated eardrum.

Injury

A perforated eardrum is sometimes caused by an injury to the eardrum. For example, a severe blow to the ear or poking an object, such as a cotton bud, deep into the ear may perforate your eardrum.

Loud noises

A perforated eardrum can be caused by a sudden loud noise. For example, the shockwaves from a loud explosion can damage the sensitive parts of your ear, including the eardrum.

A perforated eardrum that is caused by a loud noise will often cause severe hearing loss and ringing in your ears (tinnitus).

Changes in air pressure

Sudden changes in air pressure, such as when changing altitude in an aircraft, often cause pain in the ear. Occasionally, sudden pressure changes can cause your eardrum to become perforated. As well as when flying, this could happen when you are scuba diving or driving at high altitudes.

This occurs because there is a big difference between the air pressure outside the ear and the pressure inside the middle ear.

Page last reviewed: 13/07/2011

See your GP if you have pain or discomfort in your ear for more than a couple of days.

Examining your eardrum

Your GP will use an auriscope, also known as an otoscope, to examine your eardrum.

An auriscope is an instrument with a light and a lens that allows your GP to examine the inside of your ear. If you have a perforated eardrum, your GP will be able to see a hole or tear in the eardrum.

Page last reviewed: 13/07/2011

In many cases, a perforated eardrum will heal by itself without treatment in around two months. If treatment is needed, it's mainly to relieve discomfort and treat infection.

Painkillers

Any pain or discomfort caused by a perforated eardrum can be treated using painkillers, such as paracetamol or ibuprofen. Never give aspirin to children under 16.

In some cases ibuprofen is not recommended, such as if you have had a peptic ulcer. It can also cause side effects.

You may want to try placing a hot water bottle wrapped in a towel against your ear, as this sometimes relieves any discomfort.

Antibiotics

Your GP may prescribe antibiotics if your perforated eardrum was caused by an infection, or if there is a risk that an infection will develop while your eardrum heals. You may be prescribed antibiotic eardrops or tablets to be swallowed.

Surgery

You may need surgery if your perforated eardrum is severe or doesn't heal. The procedure used to repair a perforated eardrum is known as a myringoplasty.

A myringoplasty may be recommended to:

  • prevent water from entering your middle ear (which could cause an infection)
  • reduce your likelihood of getting ear infections
  • improve your hearing

The procedure

If you decide to have a myringoplasty, you will be admitted to the specialist ear, nose and throat (ENT) department of your local hospital. Depending on your circumstances, the time you will need to spend in hospital will vary from a few hours to two days.

The myringoplasty procedure will be carried out under general anaesthetic, so you will be asleep throughout the procedure. It usually takes an hour or two. A small piece of tissue is usually taken from above your ear and is used to seal up the hole in your eardrum. This is known as a graft.

The surgeon uses a microscope and very small surgical equipment to seal up the hole with the skin graft. Sometimes, a cut is made behind your ear to access your eardrum more easily.

After the procedure, a dressing will be placed inside your ear canal and cotton wool padding will be put over your ear and held in place with a bandage. You may also have some stitches.

Recovery

You will need two weeks off school or work after your operation. During this time, you should avoid:

  • sudden head movement
  • contact sports or strenuous exercise
  • heavy lifting
  • people who have a cough or cold, so that you don't catch their infection

If you have stitches, these will be removed after around a week.

A myringoplasty should not cause too much pain, but if necessary you can take painkillers, such as paracetamol. You may experience some dizziness for two or three weeks.

Two to four weeks after your operation, you will have an appointment at the outpatient clinic to have your dressings removed and your ear checked.

Keep any wounds dry until they have healed. Do not go swimming and keep your ear covered when you have a shower or bath. Do not fly until your doctor says it is safe to do so.

Antibiotics
Antibiotics are medicines that can be used to treat infections caused by micro-organisms, usually bacteria or fungi. Examples of antibiotics include amoxicillin, streptomycin and erythromycin.
Anaesthetic
Anaesthetic is a drug used to numb a part of the body (local) or to put a patient to sleep (general) during surgery.
Painkillers
Painkillers, or analgesics, are medicines that relieve pain. Examples of painkillers include paracetamol, aspirin and ibuprofen.
Tissue
Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.

Avoid getting water in your ear

Do not get water in your ear while your eardrum heals. When showering, wear a shower cap over your ears or gently place a ball of cotton wool into the ear. Do not go swimming while your eardrum is healing.

Page last reviewed: 13/07/2011

Before you have surgery to repair a perforated eardrum (myringoplasty), discuss it with your surgeon. They can tell you about any problems you may have as a result of the procedure.

Complications associated with a myringoplasty are rare, but may include those below.

Infection

It's possible to have an infection after surgery. If your ear is infected, you will experience an increase in pain, bleeding and discharge. Contact your GP if you think you may have an infection.

Hearing loss

Severe deafness can occur if your inner ear is damaged during surgery, although this is very rare.

Read more about hearing loss.

Tinnitus

Following surgery, you may experience ringing or buzzing in your ear, known as tinnitus.

Dizziness

It is common to experience dizziness for a few hours after surgery. In a small number of cases, the dizziness can last for longer.

Facial paralysis

The nerve that controls facial muscles runs through the ear, so there is a slight risk of facial paralysis (weakness in the muscles of the face) after surgery.

Sometimes, facial paralysis develops soon after surgery but there can be a delay between having surgery and the start of symptoms. The facial muscles may recover totally or partially.

Taste

As the taste nerve passes close to your eardrum, there is a risk that it may be damaged during surgery. If the nerve is damaged, you may have a strange taste on one side of your tongue. This is usually temporary, but occasionally it can be permanent.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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