Perforated Eardrum

Article Translations: (Spanish)

Darren lost his balance while waterskiing. As he fell sideways, his head slapped against the water and he felt a sharp pain inside his ear. When Darren put his fingers to his ear he saw blood. He also realized he couldn't hear as well from that ear.

Darren's parents called the doctor and got him an appointment right away. The doctor looked in Darren's ear and told him he had a perforated eardrum.

What Is a Perforated Eardrum?

A perforated eardrum is a tear or hole in the ear's tympanic membrane (the medical name for your eardrum). A perforated eardrum is also sometimes called a ruptured eardrum.

A perforated eardrum can really hurt. And if you can't hear as well as usual, it can be pretty scary. The good news is, most people who have a perforated eardrum get all their hearing back eventually.

If you think you have a perforated eardrum, see a doctor. A tear in the eardrum can allow bacteria and other things to get into the middle ear and inner ear. If that happens, an infection could develop that can cause more hearing loss.

Most perforated eardrums heal in a few weeks. Sometimes, though, doctors need to do surgery to repair the tear.

How the Eardrum Works

The eardrum is a thin piece of skin-like tissue that's stretched tight — like a drum — across the opening between the ear canal and the middle ear.

The outer ear funnels sound waves into the ear canal that hit the eardrum and make it vibrate. The middle ear and inner ear convert the vibrations to signals that the brain interprets as sounds.

If there is a hole in the eardrum, it can't always vibrate as well as it should. This can make a person's hearing worse.

Causes of a Perforated Eardrum

You've probably already know not to stick cotton swabs or other things into the ear canal when cleaning your ears. But eardrums can get ruptured a number of ways, and not all of them involve puncturing them with a swab.

Here are some things that may cause perforated eardrums in teens:

• Sudden pressure changes (barotraumas). Most of the time, the air pressure in the middle ear and the pressure in the environment are in balance. But some things — like flying in an airplane, driving on a mountain road, or scuba diving — can cause a sudden change in pressure that may rupture an eardrum.
• Loud noises (acoustic trauma). Really loud noises, like an explosion, can produce sound waves that are strong enough to damage the eardrum. Luckily, this doesn't happen often. Loud noise also can cause temporary or permanent damage to the cochlea.
• Foreign objects. Thinks like cotton swabs or bobby pins may poke through the eardrum if pushed into the ear.
• Head trauma. A direct blow to the ear or a severe head injury from something like a car accident can fracture (break) the skull bone and tear the eardrum.
• Direct trauma to the pinna and outer ear canal. A slap on the ear with an open hand or other things that put pressure on the ear can tear the eardrum.
• Ear infections. An infection of the middle ear or inner ear can cause pus or fluid to build up behind the eardrum. This can make the eardrum burst open.

What Are the Symptoms?

The first sign of a perforated eardrum will probably be pain. Here's what someone might notice after tearing an eardrum:

• mild to severe pain that may increase for a time before suddenly decreasing
• drainage from the ear that can be clear, pus-filled, or bloody
• hearing loss
• ringing or buzzing in the ear (tinnitus)
• dizziness or vertigo (a feeling that the room is spinning) that can cause nausea or vomiting
• weakness in the muscles of the face (this doesn't happen a lot)

Talk to a parent or call a doctor right away if you have any symptoms of a perforated eardrum. You should also see a doctor if you continue to have symptoms after getting treatment for a perforated eardrum. Even though most perforations heal on their own, you want to take steps to make sure any hearing loss you experience is only temporary.

Go to the emergency room right away if you have severe symptoms. Examples of severe symptoms are bloody discharge from your ear, extreme pain, total hearing loss in one ear, or dizziness that causes vomiting.

Diagnosing a Perforated Eardrum

To check for a perforated eardrum, a doctor will most likely examine your ear canal with a lighted instrument called an otoscope. Often, a doctor can see the tear and may even be able to see the tiny bones of the middle ear. Other times it can be hard to see the eardrum at all because of fluid draining from the ear.

A doctor might order additional tests. Some of these are to check the eardrum for a rupture, others help doctors learn more about hearing loss. The doctor may want you to get an audiology exam to measure how well you hear at different pitches and volumes.

If there is fluid coming from the ear, a sample of the fluid might be tested in a lab. This can help doctors decide which antibiotic is best for treating the infection.

What's the Treatment?

Usually, a perforated eardrum will heal on its own within a few weeks without any treatment. While the eardrum is healing, over-the-counter pain relievers can help ease any pain. Ask your health care professional or a parent which pain relievers are best for you.

To help prevent infections (or treat any existing infections), a doctor may prescribe antibiotics. Antibiotics are usually a pill that you'll swallow, but sometimes can be ear drops.

Here are three things to avoid doing if you have a perforated eardrum:

1. Never use over-the-counter ear drops unless your doctor specifically tells you to. If there is a hole in the eardrum, some kinds of ear drops can get into the middle ear or cochlea and cause problems.
2. Avoid getting water inside the ear canal. Your doctor might recommend that you keep your ear dry during water activities to prevent infection while the eardrum heals. This can be done by gently placing a waterproof earplug or cotton ball coated with petroleum jelly in your ear when you shower or take a bath.
3. Don't clean your ear or forcefully blow your nose. Wait until the tear in your eardrum is completely healed.

If your eardrum doesn't heal on its own, an ear-nose-throat (ENT) specialist may recommend an eardrum patch. During this procedure, a doctor puts a paper patch over the hole. Doctors may need to do this procedure a number of times until the eardrum is fully healed.

If all other treatments fail, the ENT specialist might have to do a kind of surgery known as a tympanoplasty. The surgeon will attach a small patch of your own tissue to close the tear on your eardrum.

Preventing a Perforated Eardrum

Sometimes you can't prevent a perforated eardrum (like when an eardrum ruptures because of infection, for example). But a lot of eardrum perforations are 100% preventable.

To make the chances of a rupture very unlikely:

• Call your doctor right away if you notice any signs of an ear infection.
• Never stick anything in your ear, even to clean it. If you get something stuck in your ear, have it removed by a health care provider — don't try to get it out at home as this could damage your ear.
• Try to avoid flying on airplanes if you have a cold or sinus infection. If you have to fly, chew some gum during takeoff and landing. You can also try to equalize the pressure in your ears by yawning or swallowing. But don't try that trick of blowing your nose while pinching your nostrils shut. Doctors don't recommend this.
• Get lessons and a certification if you plan to go scuba diving. Make sure you learn how to equalize the pressure in your ears. Don't scuba dive if you have an ear infection, sinus infection, or cold.

Perforated eardrums can be scary at first, so it helps to remember that most clear up on their own. But you'll still want to see a doctor and get the right advice on how to make this happen.

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