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Ruptured eardrum

Definition

A ruptured eardrum is an opening or hole in the eardrum, which separates the outer and middle ear. When the eardrum is damaged, the hearing may be harmed.

Alternative Names

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

Causes

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 (rupture).

Damage to the eardrum can also occur from:

• A very loud noise close to the ear, such as a gunshot
• A rapid change in ear pressure, 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

Ear pain may suddenly decrease right after your eardrum ruptures.

After the rupture, you may have:

• Drainage from the ear (drainage may be clear, pus, or bloody)
• Ear noise/buzzing
• Earache or ear discomfort
• Hearing loss in the involved ear (hearing loss may not be total)
• Weakness of the face, or dizziness (in more severe cases)

Exams 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.

Audiology testing can measure how much hearing has been lost.

Treatment

Putting warmth on the ear may help relieve discomfort. Painkillers such as ibuprofen or acetaminophen may be used to relieve pain.

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 or treat an infection.

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.

Outlook (Prognosis)

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

Rarely, other problems may occur, such as:

• Long-term hearing loss
• Spread of infection to the bone behind the ear (mastoiditis)
• Long-term vertigo and dizziness

When to Contact a Medical Professional

If your pain and symptoms improve after your eardrum ruptures, you may wait until the next day to see your health care provider.

Call your health care provider right away after your eardrum ruptures if you:

• Are very dizzy
• Have a fever, general ill feeling, or hearing loss
• Have very bad pain or a loud ringing in your ear
• Have an object in your ear that does not come out
• 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

Buttaravoli P, Leffler SM. Perforated tympanic membrane (ruptured eardrum). In: Buttaravoli P, Leffler SM, eds. Minor Emergencies. 3rd ed. Philadelphia, Pa: Mosby Elsevier; 2012:chap 37.

Kerschner JE. Otitis media. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 632.

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