Ruptured Eardrum

Ruptured eardrum (perforated eardrum)
Overview
A ruptured eardrum — or tympanic membrane perforation as it's medically known — is a hole or tear in the thin tissue that separates your ear canal from your middle ear (eardrum).

A ruptured eardrum can result in hearing loss. A ruptured eardrum can also make your middle ear vulnerable to infections or injury.

A ruptured eardrum usually heals within a few weeks without treatment. Sometimes, however, a ruptured eardrum requires a procedure or surgical repair to heal.

Symptoms
Signs and symptoms of a ruptured eardrum may include:

Ear pain that may subside quickly
Clear, pus-filled or bloody drainage from your ear
Hearing loss
Ringing in your ear (tinnitus)
Spinning sensation (vertigo)
Nausea or vomiting that can result from vertigo
When to see a doctor
Call your doctor if you experience any of the signs or symptoms of a ruptured eardrum or pain or discomfort in your ears. Your middle and inner ears are composed of delicate mechanisms that are sensitive to injury or disease. Prompt and appropriate treatment is important to preserve your hearing.

Causes
Causes of a ruptured, or the perforated, eardrum may include:

Middle ear infection (otitis media). A middle ear infection often results in the accumulation of fluids in your middle ear. Pressure from these fluids can cause the eardrum to rupture.
Barotrauma. Barotrauma is stress exerted on your eardrum when the air pressure in your middle ear and the air pressure in the environment are out of balance. If the pressure is severe, your eardrum can rupture. Barotrauma is most often caused by air pressure changes associated with air travel.

Other events that can cause sudden changes in pressure — and possibly a ruptured eardrum — include scuba diving and a direct blow to the ear, such as the impact of an automobile airbag.

Loud sounds or blasts (acoustic trauma). A loud sound or blast, as from an explosion or gunshot — essentially an overpowering sound wave — can cause a tear in your eardrum.
Foreign objects in your ear. Small objects, such as a cotton swab or hairpin, can puncture or tear the eardrum.
Severe head trauma. Severe injury, such as skull fracture, may cause the dislocation or damage to middle and inner ear structures, including your eardrum.
Complications
Your eardrum (tympanic membrane) has two primary roles:

Hearing. When sound waves strike it, your eardrum vibrates — the first step by which structures of your middle and inner ears translate sound waves into nerve impulses.
Protection. Your eardrum also acts as a barrier, protecting your middle ear from water, bacteria and other foreign substances.
If your eardrum ruptures, complications can occur while your eardrum is healing or if it fails to heal. Possible complications include:

Hearing loss. Usually, hearing loss is temporary, lasting only until the tear or hole in your eardrum has healed. The size and location of the tear can affect the degree of hearing loss.
Middle ear infection (otitis media). A perforated eardrum can allow bacteria to enter your ear. If a perforated eardrum doesn't heal or isn't repaired, you may be vulnerable to ongoing (chronic) infections that can cause permanent hearing loss.
Middle ear cyst (cholesteatoma). A cholesteatoma is a cyst in your middle ear composed of skin cells and other debris.

Ear canal debris normally travels to your outer ear with the help of ear-protecting earwax. If your eardrum is ruptured, the skin debris can pass into your middle ear and form a cyst.

A cholesteatoma provides a friendly environment for bacteria and contains proteins that can damage the bones of your middle ear.

Prevention
Follow these tips to avoid a ruptured or perforated eardrum:

Get treatment for middle ear infections. Be aware of the signs and symptoms of middle ear infection, including earache, fever, nasal congestion and reduced hearing. Children with middle ear infection often rub or pull on their ears. Seek prompt evaluation from your primary care doctor to prevent potential damage to the eardrum.
Protect your ears during flight. If possible, don't fly if you have a cold or an active allergy that causes nasal or ear congestion. During takeoffs and landings, keep your ears clear with pressure-equalizing earplugs, yawning or chewing gum. Or use the Valsalva maneuver — gently blowing, as if blowing your nose, while pinching your nostrils and keeping your mouth closed. Don't sleep during ascents and descents.
Keep your ears free of foreign objects. Never attempt to dig out excess or hardened earwax with items such as a cotton swab, paper clip or hairpin. These items can easily tear or puncture your eardrum. Teach your children about the damage that can be done by putting foreign objects in their ears.
Guard against excessive noise. Protect your ears from unnecessary damage by wearing protective earplugs or earmuffs in your workplace or during recreational activities if a loud noise is present.