What is a perforated eardrum?
A perforated eardrum is a hole or tear in the eardrum. It can be uncomfortable, but usually heals on its own without treatment within two months.
The eardrum, also known as the tympanic membrane, is a thin layer of tissue that separates the outer ear from the middle ear.
Read more about the symptoms of a perforated eardrum.
When to get medical help
See your doctor if you have pain or discomfort in your ear for more than a couple of days.
Your doctor will use a special instrument called an auriscope or otoscope to examine your eardrum.
An auriscope has a light and a lens that allows your doctor to examine the inside of your ear. If you have a perforated eardrum, your doctor will be able to see a hole or tear in the eardrum.
Treating a perforated eardrum
Most cases do not need treatment and your perforated eardrum should heal itself within a couple of months. Painkillers, such as ibuprofen or paracetamol, should ease any pain or discomfort. Avoid getting your ear wet while it heals.
Your doctor may prescribe antibiotics if an infection is the cause of your perforated eardrum or you are at risk of infection.
Surgery to repair the eardrum (myringoplasty) may be necessary in severe cases or if your eardrum doesn't heal.
Read more about treating a perforated eardrum.
Complications associated with myringoplasty are rare, but may include infection, hearing loss or dizziness.
Symptoms of a perforated eardrum
If you have a perforated eardrum, your hearing may be affected.
The extent of any hearing loss will depend on the size of the hole in your eardrum. A small puncture may only cause a slight loss of hearing, whereas a large puncture is likely to cause greater hearing loss.
The hearing loss is only temporary and your hearing will return once your eardrum has healed.
As well as hearing loss, a perforated eardrum may cause the following symptoms:
Risk of infection
The eardrum forms a protective barrier that prevents germs and bacteria from entering your middle ear. If you have a perforated eardrum, your risk of developing an ear infection is therefore increased.
If you have an infection of the middle ear, your symptoms may include:
- severe earache caused by the pressure of the mucus on the eardrum
- a high temperature (fever) of 38ºC (100.4ºF) or above
- slight hearing loss
Spotting an ear infection in children
Children who have an ear infection may also develop flu-like symptoms, such as vomiting and a lack of energy. Babies with ear infections will be hot and irritable.
Other signs of an ear infection in children and babies are:
- pulling, tugging or rubbing their ear
- a high temperature (38ºC or above)
- poor feeding
- restlessness at night
- runny nose
- not responding to quiet sounds
- loss of balance
What causes a perforated eardrum?
A perforated eardrum can have several different causes.
Middle ear infection
An infection of the middle ear is one of the most common causes of a perforated eardrum. If you have an ear infection, pus can build up inside your ear and put pressure on your eardrum.
Sometimes, the amount of pus in your ear can build up so much that the eardrum bursts, allowing the pus to escape. This mucus discharge is a common symptom of a perforated eardrum.
A perforated eardrum is sometimes caused by an injury to the eardrum. For example, a severe blow to the ear or poking an object such as a cotton bud deep into the ear may perforate your eardrum.
A perforated eardrum can be caused by a sudden loud noise. For example, the shockwaves from a loud explosion can damage the sensitive parts of your ear, including the eardrum.
A perforated eardrum caused by a loud noise will often cause severe hearing loss and ringing in your ears (tinnitus).
Changes in air pressure
Sudden changes in air pressure, such as when changing altitude in an aircraft, often cause pain in the ear. Occasionally, sudden pressure changes can cause your eardrum to become perforated. This can also happen when you are scuba diving or driving at high altitudes.
This occurs because there is a big difference between the air pressure outside the ear and the pressure inside the middle ear.
Treatment for a perforated eardrum
In many cases, a perforated eardrum will heal by itself in around two months without treatment. If treatment is needed, it's mainly to relieve discomfort and treat infection.
You may want to try placing a hot water bottle wrapped in a towel against your ear, as this sometimes relieves any discomfort.
Your doctor may prescribe antibiotics if your perforated eardrum was caused by an infection or if there is a risk that an infection will develop while your eardrum heals. You may be prescribed antibiotic eardrops or tablets.
You may need surgery if your perforated eardrum is severe or doesn't heal. The procedure used to repair a perforated eardrum is known as a myringoplasty.
A myringoplasty may be recommended to:
- prevent water from entering your middle ear, which could cause an infection
- reduce your likelihood of getting ear infections
- improve your hearing
If you decide to have a myringoplasty, you will be admitted to the specialist ear, nose and throat (ENT) department of your local hospital. Depending on your circumstances, the time you will need to spend in hospital can vary from a few hours to a couple of days.
The myringoplasty procedure will be carried out under general anaesthetic and usually takes an hour or two to perform. A small piece of tissue is usually taken from above your ear and is used to seal up the hole in your eardrum. This is known as a graft.
The surgeon uses a microscope and very small surgical equipment to seal up the hole with the skin graft. Sometimes, a cut is made behind your ear to access your eardrum more easily.
After the procedure, a dressing will be placed inside your ear canal and cotton wool padding will be put over your ear and held in place with a bandage. You may also have some stitches.
You will need two weeks off school or work after your operation. During this time, you should avoid:
- sudden head movements
- contact sports or strenuous exercise
- heavy lifting
- people who have a cough or cold, so that you don't catch their infection
If you have stitches, these will be removed after around a week.
A myringoplasty should not cause too much pain, but if necessary you can take painkillers. You may experience some dizziness for two or three weeks.
Two to four weeks after your operation, you will have an appointment at the outpatient clinic to have your dressings removed and your ear checked.
Keep any wounds dry until they have healed. Do not go swimming and keep your ear covered when you have a shower or bath. Do not fly until your doctor says it is safe to do so.
Complications of a perforated eardrum
Complications associated with surgery for a perforated eardrum (myringoplasty) are rare, but may include infection, hearing loss or dizziness.
Before you have surgery to repair a perforated eardrum, discuss it with your surgeon. They can tell you about any problems you may have as a result of the procedure.
It's possible to have an infection after surgery. If your ear is infected, you will experience an increase in pain, bleeding and discharge. Contact your doctor if you think you may have an infection.
Severe deafness can occur if your inner ear is damaged during surgery, although this is very rare.
Read more about hearing loss.
Following surgery, you may experience ringing or buzzing in your ear known as tinnitus.
It is common to experience dizziness for a few hours after surgery. In a small number of cases, the dizziness can last for longer.
The nerve that controls facial muscles runs through the ear, so there is a slight risk of facial paralysis (weakness in the muscles of the face) after surgery.
Sometimes, facial paralysis develops soon after surgery, but there can be a delay between having surgery and the start of symptoms. The facial muscles may recover totally or partially.
As the taste nerve passes close to your eardrum, there is a risk that it may be damaged during surgery. If the nerve is damaged, you may have a strange taste on one side of your tongue. This is usually temporary, but occasionally it can be permanent.