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A perforated eardrum happens when you have a perforation (a tear, or rupture) of the eardrum. Your eardrum is a thin membrane that separates your outer ear from your middle ear. The medical term for the eardrum is the tympanic membrane, so a perforated eardrum or eardrum perforation is also known as tympanic membrane perforation.

If you have a perforated eardrum, there is a good chance it will heal on its own within a few weeks if it is kept dry and doesn’t become infected. However, treatment is needed in some cases.

Symptoms of a perforated eardrum

Signs and symptoms that you may have a perforated eardrum include:

• hearing loss (this can vary in severity, depending on how bad the rupture is);
• pain in the ear (especially if the ear was injured, or becomes infected);
• discharge of fluid from the ear (this may be clear, or contain pus or blood);
• noise, such as ringing or buzzing in the ear (tinnitus);
• dizziness or a spinning sensation (vertigo);
• earache or pain that suddenly goes away (when the eardrum ruptures it releases the pressure that has built up due to a middle ear infection);
• air coming out of your ear when you blow your nose (normally air rises up in the middle ear when you blow your nose, but if you have a perforated eardrum the air escapes making a noise).

If you have a middle ear infection (otitis media) associated with the perforated eardrum, you may also have a fever.

What to do if you think you have a perforated eardrum

If you think you may have a perforated eardrum, see your doctor for advice. Although most perforations heal on their own over time, sometimes treatment is needed.

Keep your ear dry. It’s very important to keep your ear dry if the eardrum membrane has been ruptured, because any water that gets inside the ear could lead to infection. To help with this, wear earplugs or a shower cap to cover your ears when showering, and avoid swimming.

You should also protect your eardrum by avoiding blowing your nose (this puts pressure on the eardrum) or cleaning inside your ear.

What causes eardrum perforation?

Common causes of eardrum perforation include:

• middle ear infection (otitis media) – (this can cause a build-up of fluid, increasing pressure in the middle ear that causes the eardrum to rupture;
• sudden changes in air pressure inside the ear (barotrauma), such as during air travel or scuba diving;
• sudden loud noise (acoustic trauma), such as an explosion;
• injury from an object forced into the ear, such as an ear bud or match stick;
• a hard blow to the ear or head, such as a slap or from a sports injury.

Less common causes of a perforated eardrum include:

• ear syringing – accidental damage during ear syringing (a procedure used by doctors to rinse out ear wax and other blockages);
• disorders of the Eustachian tube (a small tube that controls pressure inside the middle ear);

Who is at risk?

Since eardrum perforation can result from middle ear infection, people who are susceptible to middle ear infections may also be at risk of a perforated eardrum. This includes young children, most of whom will have a middle ear infection at least once before they reach school age.

In Australia, Aboriginal and Torres Strait Islander children are particularly susceptible to middle ear infection and eardrum perforation.

Complications of eardrum perforation

The eardrum plays an important part in enabling us to hear sounds, so damage to the eardrum can lead to problems with hearing. Usually such problems go away once the perforation has healed.

The eardrum also plays an important role in protecting the inside of the ear. As a barrier between the outer and middle ear, it helps prevent water, bacteria and other contaminants from getting in. If the membrane is damaged, the middle ear can become infected. If the infection becomes chronic (ongoing), hearing loss may get worse, last longer, or in some cases, become permanent.

Another potential complication of eardrum perforation is developing a type of skin cyst called a cholesteatoma.This can happen when debris from the ear canal gets into the middle ear. As it grows, the cyst can damage the bones of the middle ear and lead to significant problems.

Tests and diagnosis

When you go to a doctor with symptoms of a perforated eardrum, he or she is likely to take your medical history and ask you about what may have caused the problem, such as an injury or exposure to very loud noise.

The doctor will also need to examine your ear. To diagnose a perforated eardrum, a lighted instrument called an otoscope is used to look inside the ear and see if there is a hole or tear in the membrane. Other tests may also be done to assess hearing loss, the extent of damage to the eardrum, or the cause of the perforation.

Such tests include:

• tuning fork testing (using tuning forks to test hearing);
• audiology (testing hearing in a sound-proof booth);
• free field testing (where the doctor uses his/her voice at different volumes and distances);
• laboratory cultures of fluid samples from the ear to test for bacterial infection.

Treatment

Most eardrum perforations heal without treatment. However, if you have an ear infection, or your doctor believes you are at risk of getting an ear infection before the eardrum has healed, you may need to take antibiotics.

Eardrum repair

If the eardrum does not heal properly on its own, your GP may refer you to a specialist called an ENT (ear, nose and throat) surgeon. If necessary, the eardrum membrane can be repaired using a surgical procedure. Eardrum repairs are usually successful.

Surgical procedures to repair a perforated eardrum are:

• Tympanoplasty: this is used for a larger hole in the eardrum and involves grafting a small patch of your own tissue over the hole in the eardrum. It is usually done under general anaesthetic.
• Patching: this is used for smaller holes in the eardrum and involves the doctor applying a small patch to the hole in the eardrum. It can be done with local anaesthesia.

Self-care

To care for a perforated eardrum while it heals:

• keep the affected ear dry at all times;
• hold something soft and warm, like a heated face washer, against the ear to help relieve discomfort;
• control pain using pain killers such as paracetamol (e.g. Panadol) or ibuprofen (e.g. Nurofen);
• avoid blowing your nose.

Can I fly when I have a perforated eardrum?

Yes. It is usually safe to fly with a perforated eardrum. It may actually cause less discomfort than flying with a normal eardrum, as the pressure is more easily able to equalise due to the hole in the eardrum.

Prevention

There are some simple things you can do to try to prevent eardrum perforation:

• Don’t put anything inside your ear that could damage your eardrum. This includes cotton buds, paper clips, match sticks, hair pins, pencils, or any other hard object.
• Protect your ears by using ear plugs or ear muffs when you are exposed to loud noise.
• Seek medical treatment if you have any symptoms of a middle ear infection.
• Avoid air travel if your ears or nose are blocked, such as if you have a head cold or an allergy that causes congestion.
• If you get a foreign object in your ear, don’t try and remove it yourself. You may rupture the eardrum. Seek medical attention.

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