Ruptured eardrum

Answer 1

Definition

A ruptured or perforated eardrum is an opening in the tympanic membrane (eardrum).

Alternative Names

Tympanic membrane perforation; Eardrum - ruptured or perforated; Perforated eardrum

Causes, incidence, and risk factors

The tympanic membrane (eardrum) separates the outer ear from the middle ear. The eardrum vibrates when sound waves strike it.

Bones and nerve endings in the middle and inner parts of the ear then send a nerve impulse that travels to the brain. When the eardrum is damaged, the hearing process is interrupted.

Ear infections may cause a ruptured eardrum, more often in children. The infection causes pus or fluid to build up behind the eardrum. As the pressure increases, the eardrum may break open or rupture.

Damage to the eardrum can also occur from:

• A very loud noise (acoustic trauma)
• Difference in pressure between the inside and outside of the eardrum (barotrauma), which may occur when flying, Scuba diving, or driving in the mountains
• Foreign objects in the ear
• Inserting cotton-tipped swabs or small objects into the ear to clean them
• Trauma to the ear (such as a powerful slap or explosion)

Symptoms

• Drainage from the ear (drainage may be clear, pus, or bloody)
• Ear noise/buzzing
• Earache or ear discomfort
  • May be severe and increasing
  • There may be a sudden decrease in ear pain followed by ear drainage
• Facial weakness or dizziness (in more severe cases)
• Hearing loss in the affected ear (hearing loss may not be complete)

Signs and tests

The doctor will look in your ear with an instrument called an otoscope. If the eardrum is perforated, the doctor will see an opening in it, and may even see the bones of the middle ear.

Sometimes it is hard for the doctor to see the eardrum because of drainage (pus) from the ear.

Audiologytesting can measure the extent of hearing loss.

Treatment

The goal of treatment is to relieve pain and prevent or treat infection.

Putting warmth on the ear may help relieve discomfort. Keep the ear clean and dry while it is healing. Place cotton balls in the ear while showering or shampooing to prevent water from entering the ear. Avoid swimming or putting your head underneath the water.

Antibiotics (oral or ear drops) may be used to prevent infection or to treat an existing infection. Analgesics (painkillers), including over-the-counter medications, may be used to relieve pain.

Sometimes the health care provider may place a patch over the eardrum to encourage healing. Surgical repair of the eardrum (tympanoplasty) may be needed if the eardrum does not heal on its own.

Expectations (prognosis)

A ruptured or perforated eardrum may be uncomfortable, but it usually heals by itself within 2 months. Any hearing loss is usually temporary.

Complications

• Ear infection (otitis media): The eardrum prevents bacteria from entering the middle ear. When the eardrum is ruptured, bacteria can easily travel to the middle ear, causing an infection.
• Permanent hearing loss
• Spread of infection to the bone behind the ear (mastoiditis)

Calling your health care provider

Call your health care provider if you:

• Have symptoms of a ruptured or perforated eardrum
• Are diagnosed with a ruptured eardrum, and symptoms last longer than 2 months despite medical treatment
• Are diagnosed with a ruptured eardrum and develop ear drainage, a persistent fever, general ill feeling, or hearing loss

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.

References

Kerschner JE. Otitis media. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 639.

Bauer CA, Jenkins HA. Otologic symptoms and syndromes. In: Cummings CW, Flint PW, Haughey BH, Robbins KT, Thomas JR, eds. Otolaryngology: Head & Neck Surgery. 4th ed. Philadelphia, PA: Mosby Elsevier; 2005:chap 126.

Ramakrishnan K, Sparks RA, Berryhill WE. Diagnosis and treatment of otitis media. Am Fam Physician. 2007;76(11):1650-1658.

Answer 2

Definition

A ruptured eardrum is an opening or hole in the thin layer of tissue (eardrum) that separates the outer and middle ear.

Alternative Names

Tympanic membrane perforation; Eardrum - ruptured or perforated; Perforated eardrum

Causes, incidence, and risk factors

The eardrum vibrates when sound waves strike it. These vibrations then pass through the bones of the middle ear. They stimulate the inner ear, sending nerve impulses to the brain. When the eardrum is damaged, the hearing process is interrupted.

Ear infections may cause a ruptured eardrum, more often in children. The infection causes pus or fluid to build up behind the eardrum. As the pressure increases, the eardrum may break open or rupture.

Damage to the eardrum can also occur from:

• A very loud noise (acoustic trauma)
• Difference in pressure between the inside and outside of the eardrum (barotrauma), which may occur when flying, scuba diving, or driving in the mountains
• Foreign objects in the ear
• Injury to the ear (such as a powerful slap or explosion)
• Inserting cotton-tipped swabs or small objects into the ear to clean them

Symptoms

• Drainage from the ear (drainage may be clear, pus, or bloody)
• Ear noise/buzzing
• Earache or ear discomfort
  • May be severe and increasing
  • There may be a sudden decrease in ear pain followed by drainage from the ear
• Hearing loss in the affected ear (hearing loss may not be total)
• Weakness of the face, or dizziness (in more severe cases)

Signs and tests

The doctor will look in your ear with an instrument called an otoscope or a microscope. If the eardrum is ruptured, the doctor will see an opening in it, and may even see the bones of the middle ear.

Sometimes it is hard for the doctor to see the eardrum because of drainage (pus) from the ear.

Audiologytesting can measure how much hearing has been lost.

Treatment

The goal of treatment is to relieve pain and prevent or treat infection.

Putting warmth on the ear may help relieve discomfort. Keep the ear clean and dry while it is healing. Place cotton balls in the ear while showering or shampooing to prevent water from entering the ear. Avoid swimming or putting your head underneath the water.

Antibiotics (oral or ear drops) may be used to prevent infection or to treat an infection you already have. Painkillers (analgesics), including over-the-counter medications, may be used to relieve pain.

Sometimes the health care provider may place a patch over the eardrum to speed healing. Surgical repair of the eardrum (tympanoplasty) may be needed if the eardrum does not heal on its own.

Expectations (prognosis)

The opening in the eardrum usually heals by itself within 2 months. Any hearing loss is most often short-term.

Complications

• Ear infection (otitis media) (the eardrum prevents bacteria from entering the middle ear)
• Long-term hearing loss
• Spread of infection to the bone behind the ear (mastoiditis)
• Vertigo

Calling your health care provider

Call your health care provider if you:

• Have symptoms of a ruptured eardrum
• Have drainage from the ear, fever, a general ill feeling, or hearing loss that do not improve or that return after being treated
• Have any symptoms that last longer than 2 months after treatment

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.

References

Kerschner JE. Otitis media. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 639.

Bauer CA, Jenkins HA. Otologic symptoms and syndromes. In: Cummings CW, Flint PW, Haughey BH, Robbins KT, Thomas JR, eds. Otolaryngology: Head & Neck Surgery. 4th ed. Philadelphia, PA: Mosby Elsevier; 2005:chap 126.

Ramakrishnan K, Sparks RA, Berryhill WE. Diagnosis and treatment of otitis media. Am Fam Physician. 2007;76(11):1650-1658.

Reviewed By

Review Date: 04/15/2011

Seth Schwartz, MD, MPH, Otolaryngologist, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.