Perforated Eardrum
Definition
A perforated eardrum exists when there is a hole or rupture in the eardrum, the thin membrane that separates the outer ear canal from the middle ear. A perforated eardrum may cause temporary hearing loss and occasional discharge.
A perforated eardrum is caused by a hole or rupture in the eardrum, the thin membrane that separates the outer ear canal from the middle ear. It may result in temporary hearing loss and occasional discharge. (Illustration by Electronic Illustrators Group.)
Description
The eardrum (tympanic membrane) is a thin wall that separates the outer ear from the middle ear, vibrating when sound waves strike the membrane. The middle ear is connected to the nose by the Eustachian tube.
In addition to conducting sound, the eardrum also protects the middle ear from bacteria. When it is perforated, bacteria can more easily get into this part of the ear, causing ear infections.
In general, the larger the hole in the eardrum, the greater the temporary loss of hearing. The location of the perforation also affects the degree of hearing loss. Severe hearing loss may follow a skull fracture that disrupts the bones in the middle ear. Eardrumperforation caused by a loud noise may result in ringing in the ear (tinnitus), in addition to a temporary hearing loss. Over time, this hearing loss improves and the ringing usually fades in a few days.
Causes and symptoms
The eardrum can become damaged by a direct injury. It is possible to perforate the eardrum:
with a cotton-tipped swab or another foreign object
by hitting the ear with an open hand
after a skull fracture
after a loud explosion or other loud noise.
In addition, an ear infection can rupture the eardrumas pressure within the middle ear rises when fluid builds up. If the eardrum is punctured by pressure from an ear infection, there may be infected or bloody drainage from the ear.
Rarely, a small hole may remain in the eardrum after a pressure-equalizing tube falls out or is removed by a doctor.
Symptoms include an earache or pain in the ear, which may be severe, or a sudden decrease in ear pain, followed by ear drainage of clear, bloody, or pus-filled fluid, hearing loss, or ear noise/buzzing.
Diagnosis
A doctor can diagnose a perforated eardrum by direct inspection with an otoscope. Hearing tests may reveal a hearing loss.
Treatment
A perforated eardrum usually heals by itself within two months. Antibiotics may be given to prevent infection or to treat an existing ear infection. Painkillers can relieve any ear pain.
Sometimes, a paper patch is placed over the eardrum until the membrane heals. Three or four patches may be needed before the perforation closes completely. If the eardrum does not heal on its own, surgical repair (tympanoplasty) may be necessary.
The ear should be kept clean and dry while the eardrum heals; patients should insert cotton balls into the ear when showering or shampooing to block any water from getting into the ear. Pain in the ear may be eased by applying warm compresses.
Prognosis
While a perforated eardrum may be uncomfortable, it usually heals on its own. Any hearing loss that accompanies the perforation is usually temporary.
Prevention
A perforated eardrum can be prevented by avoiding insertion of any object into the ear to clean it. If a foreign object becomes lodged in the ear, only a doctor should try to remove it. Promptly treating all ear infections is another way to guard against a ruptured eardrum.
KEY TERMS
Eustachian tube—The air duct that connects the
area behind the nose to the middle ear.
Otoscope—An instrument used to examine the ear,
to inspect the outer ear canal and the eardrum, and
to detect diseases in the middle ear.
Resources
ORGANIZATIONS
American Academy of Otolaryngology-Head and Neck
Surgery, Inc. One Prince St., Alexandria VA 22314-
3357. (703) 836-4444. <http://www.entnet.org>.
Better Hearing Institute. 515 King Street, Suite 420,
Alexandria, VA 22314. (703) 684-3391.
Carol A. Turkington
