A perforated eardrum is a hole in the thin membrane between the ear canal and the middle ear. The medical name is a tympanic membrane perforation.
How a hole forms
Trauma and infection cause most of them. A direct hit with an open hand, a skull fracture, a sudden explosion, or an object pushed too far into the canal (a cotton swab, a bobby pin, a stick) can tear the drum. Hot metal from welding, or acid in the canal, can too.
A middle ear infection can build pressure until the drum ruptures. Pain and hearing loss come first. Then there may be bloody or infected drainage, and the pain often drops once the pressure is released. A pressure-equalizing tube can leave a small hole after it falls out or is removed. That is uncommon.
Hearing loss is usually present. Drainage may come and go. Pain often does not last. A larger hole, or a hole in certain parts of the drum, tends to cost more hearing. If the injury also disrupts the middle ear bones or the inner ear, the loss can be severe. After a blast or a hard blow, ringing can be loud at first and then fade over a few days, with some of the hearing returning. A hole that stays infected can cause a larger, lasting loss.
While it heals
Most perforations close on their own within weeks. Some take months. Until the drum is sealed, keep water and further injury out of the ear. No swimming, and no water in the canal in the shower. Do not use medicated or wax-softening drops unless we have said the drum is closed. A hearing test comes before any attempt to close the hole, so we know what the ear is doing.
Closing the hole keeps shower and pool water out, can improve hearing, and can quiet tinnitus. It also lowers the chance of a skin cyst in the middle ear (cholesteatoma), which can destroy ear structures if it grows.
Patch or surgery
A very small hole may be watched. In the office, under a microscope, the edges can be freshened and a thin paper patch placed so the drum grows across the gap. Hearing often improves as it closes. A few visits may be needed.
If a patch is unlikely to hold, or it does not, surgery is the next step. Tympanoplasty places tissue across the hole so it can heal. It is usually an outpatient operation, and it closes the drum and improves hearing in most people.
A perforated eardrum is examined as part of our ear, nose, and throat care. Related reading: middle ear infections and earwax.
