Ear drum perforation

What is a perforated eardrum?

A perforated eardrum, also called a burst or ruptured eardrum, is a hole or tear in the thin membrane, the tympanic membrane, that separates your outer ear from your middle ear. It usually gets better on its own within around two months, but you may need treatment such as antibiotics, or occasionally surgery.

Symptoms of a perforated eardrum

Symptoms usually start suddenly, following an ear infection, an injury, a loud noise, or a sudden change in air pressure, such as when flying. They typically affect one ear and can include:

• hearing loss, or sounds seeming muffled
• a ringing or buzzing sound in your ear (tinnitus)
• earache or ear pain, which may come on suddenly and settle quickly
• itching in your ear
• clear fluid, blood or pus leaking from your ear
• feeling dizzy
• a high temperature.

Causes and who is at risk

The most common cause of a perforated eardrum is a middle ear infection. As fluid builds up behind your eardrum, the pressure can cause it to tear. Other causes include:

• an injury to your ear, such as a hard blow or a slap
• a sudden loud noise, such as an explosion or gunfire, especially if you're close by
• a rapid change in air pressure, called barotrauma, for example when flying or scuba diving
• putting something into your ear canal, such as a cotton bud, or an accidental knock from an object.

Anyone can develop a perforated eardrum, but you may be more at risk if you have frequent ear infections, fly often, dive, or regularly clean your ears with cotton buds or similar objects.

Are there different types of perforated eardrum?

A perforated eardrum isn't usually classified into separate named types, but it can vary in a few ways:

• Size: From a small pinhole to a large tear, which affects how much your hearing is likely to be impacted
• Cause: Whether it's from infection, injury, pressure changes, or an object entering the ear
• Duration: Most perforations are acute and heal within a few weeks to two months – a perforation that hasn't healed within around three months is sometimes described as chronic, and is more likely to need surgical repair.

How is a perforated eardrum diagnosed?

Your doctor can usually diagnose a perforated eardrum by looking inside your ear with a lit instrument called an otoscope, which lets them see the eardrum clearly. They may need to remove any earwax first to get a clear view.

You may also be offered hearing tests, such as an audiogram, which checks how well you hear different sounds and tones, or tympanometry, which checks how well your eardrum moves, to see how the perforation is affecting your hearing and to help guide treatment.

How is a perforated eardrum treated?

Non-surgical treatment

Most perforated eardrums heal by themselves within around two months, and your hearing returns to normal.

You may be prescribed antibiotics, either to treat an existing ear infection or to help prevent one while your eardrum heals.

The following can help while your eardrum is healing:

• Take paracetamol or ibuprofen for any pain: A warm face cloth or heating pad on a low setting can also help
• Keep your ear dry: Use a large piece of cotton wool covered in petroleum jelly in your outer ear when washing your hair, and avoid swimming or baths becoming showers until you're told it's safe
• Avoid putting anything inside your ear: Such as cotton buds or eardrops, unless a doctor recommends them
• Avoid blowing your nose too hard: Since this can disrupt healing.

If water does get into your ear, tilt your head and gently pull your earlobe in different directions to help it drain, or use a hairdryer on its lowest heat setting, held 8 to 10cm away.

It's safe to fly with a perforated eardrum that hasn't been operated on.

Surgical treatment

If your eardrum hasn't healed by itself, usually after a few months, or the hole is large, you may be offered surgery. This is called a myringoplasty, or a tympanoplasty if the operation also involves checking or repairing the tiny bones in your middle ear, in which case the procedure to repair the bones themselves is called an ossiculoplasty.

The operation is usually done under general anaesthetic, often as a day case. Your surgeon reaches your eardrum through a small cut behind or above your ear, or sometimes through your ear canal, and places a small patch of your own tissue (a graft) over the hole to help it heal.

Dressings are placed inside your ear to hold this in place, usually for around 2 to 3 weeks, and the small cut in your skin is closed with a stitch.

Recovery usually takes a few weeks, though it can take longer. You should follow this guidance while your eardrum heals:

• Have someone stay with you for the first 24 hours: And avoid driving or alcohol during this time
• Keep your ear dry: For example using cotton wool covered in petroleum jelly when showering
• Take around a week off work or school: Potentially longer if your job involves a lot of movement or bending
• Avoid flying, swimming and strenuous sports for at least 6 weeks: Or until your follow-up appointment
• Avoid blowing your nose hard: Or holding your nose to try to clear your ears, as this can dislodge the graft.

The operation is generally successful, restoring the eardrum and improving hearing in around 9 in 10 cases.

As with any surgery, there are some risks, including the graft not taking, temporary dizziness, changes to taste, tinnitus, or, rarely, weakness of the facial muscles. Your surgeon will talk you through the risks that apply to your situation.

When should I see a doctor?

Ask for a GP appointment, or call 111, if you have:

• sudden hearing loss in one or both ears
• hearing that's been getting worse over the last few days or weeks
• hearing loss along with other symptoms, such as earache or discharge.

It might not be anything serious, but these symptoms can occasionally need prompt treatment. Go to A&E or seek immediate medical care if:

• you have signs of infection, such as: increasing pain, swelling, warmth or redness around your ear; pus draining from your ear; or a fever
• something is stuck in your ear or you think a sharp object has damaged it.

See your GP if your symptoms haven't started improving after a few weeks, or if you develop any new symptoms or your hearing changes.