Ruptured Eardrum

1 What is Ruptured Eardrum?

Ruptured eardrums mean there is a hole in your tympanic membrane or eardrum.

The eardrum is a thin membrane covering the end of the ear canal, and it separates the outer ear from middle ear. The eardrum vibrates with the sound waves and transmits it to the inner ear. Therefore, the eardrum plays a very important role in hearing.

Tears or hole in the eardrum causes profound hearing loss. Also, it opens the inner structures of the ear to outside environment. Bacteria and other pathogens can now enter the ear’s deeper passages that increase the risk of infection.

The majority of cases of ruptured eardrums heal within few weeks without any treatment. For treatment, the ruptured area of the eardrum is closed shut with patches or surgery.

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2 Symptoms

Ruptured eardrum may cause symptoms such as:

  • Momentary ear pain that often subsides quickly,
  • Drainage of fluid, which can be clear or stained with pus or blood,
  • Profound hearing loss,
  • Tinnitus, or continuous ringing in the ears,
  • Vertigo or sensation of undesirable spinning that may lead to nausea and vomiting.

Any kind of a pain in the ear must be seen by the doctor. Holes or tears in the eardrum can cause bacteria or other disease-causing pathogens to reach deeper parts of the ear.

Damage to sensitive areas of the middle and inner ear often causes irreversible loss of hearing, which can be avoided by prompt medical treatment.

3 Causes

Ruptured eardrums can be caused by the following conditions:

  • Direct trauma to the ear can puncture the eardrums. Using cotton swabs, hairpin or foreign objects to clean the ears can easily puncture the thin and delicate eardrum.
  • Having otitis media or swimmer’s ear. Otitis media often cause fluid buildup that can rupture the eardrums when too much as accumulated in the middle ear. 
  • Barotrauma, or too high differences in air pressure in the middle ear and that in the outside environment. The middle ear is an enclosed air-filled cavity, and the opening of the Eustachian tube equalizes the air pressure to the outside of the body. If the air pressure difference becomes too high, the eardrum can give way and sustain a tear. This can happen on sudden changes in altitude like during air travel, diving too quickly on scuba diving or sudden direct blow to the ear. Many cases of ruptured eardrums are caused slapping blows to the ears and airbags hitting the side of the head.
  • Exposure to very loud sounds like explosions, close-range gunshots, or getting close to speakers in concerts can rupture your eardrums. The ear pain caused by exposure to loud sounds means that your eardrums are reaching its breaking point.
  • Head injuries can be very severe cause trauma to inner structures of the head and result in problems like ruptured eardrums.

4 Making a Diagnosis

Your family doctor or general practitioner can easily diagnose ruptured eardrum by using an otoscope. It is inserted into your ear canal and allows visualization of the eardrum.

For the worse cases, you may be referred to a specialist doctor called ENT or otolaryngologist, which treats patients with problems in the ears, nose, and throat.

Before you go to the doctor, you can do simple things to help improve the care you receive.

List important things like symptoms including unrelated ones, events that may have something to do with the ear problem, and medications you are currently taking. Also, include questions you want to ask your doctor

Your doctor might ask you the following

  • Description of symptoms, including seemingly unrelated ones like vertigo
  • Your methods of cleaning the ears
  • History of ear infection like swimmer’s ear (otitis media)
  • Being in places like construction or mining sites, concerts, gun range, places of conflict that could have exposed you to loud sounds
  • Have you engaged in flying, swimming or diving activities recently?
  • Recent head injuries

The doctor may order lab tests to check for infection and perform procedures to check your hearing acuity.

If you suspect to have sustained a ruptured eardrum, make sure to keep your ears dry to avoid infection. Do not engage in swimming or diving activities or immerse in bathtubs.

When showering or bathing, make sure to keep your ears dry by placing a silicone ear plug (or a cotton ball coated with petroleum jelly).

Unless instructed by a doctor, never put medicated ear drops in your ear.

5 Treatment

Small tears in ruptured eardrum usually heal by itself within few weeks without treatment. But you still need to have it checked by a doctor regularly to assess for infection and monitor progress.

If there is an infection, the doctor may prescribe antibiotic drops.

For ruptured eardrum caused by problems like otitis media, the doctor will treat the underlying condition.

In case the hole in the eardrum does not heal by itself, the doctor refers you to the specialist. The otolaryngologist may seal the hole with a patch. The doctor may also apply a medication on the edges of the hole to promote healing. This patch procedure can be done twice.

If the patch failed, the doctor might do a quick surgery by grafting a patch of your own tissue to close the hole in the eardrum. Unless there are other issues like infection, this procedure is usually very short and does not require general anesthesia or hospital stay.

6 Prevention

You can prevent ruptured eardrum by following these tips:

  • Avoid exposure to loud noises as much as possible. In such environments, protect your ears by wearing safety earplugs or earmuffs.
  • Try to avoid flying if you have colds, flu or nasal allergies. During ascents and descents, you can reduce pressure in your ears by yawning, chewing gum or using special pressure-equalizing earplugs. It is also important not to be asleep when the plane is on take-off, increasing altitude, or landing.
  • You can also equalize pressure inside the ears by gently blowing the nose while pinching the nostrils and keeping the mouth closed. Do not do this if your eardrum is already ruptured.
  • Keep in mind that items like cotton swabs and objects like hairpins, pen caps and a paper clip can easily puncture the eardrums. Do not use these objects in cleaning the ears. Teach children not to clean their ears.
  • Always treat middle ear infections immediately. Signs and symptoms include pain in the ears, fever, running nose and reduced hearing, and children may rub or pull their ears.

7 Lifestyle and Coping

In order to cope with a ruptured eardrum, make sure to follow your doctor's orders as to not further disrupt the condition during healing.

Unless there is an infection or the hole is too large, ruptured eardrums heal on its own without treatment.

Healing can take several weeks to months, so make sure to do these things to avoid delays:

  • Do not insert anything, including cotton swabs, into the ear canal.
  • Do not clean your ears so the eardrum will heal normally.
  • Keep your ears dry at all times. Use a cotton ball smeared with petroleum jelly or silicone earbuds to cover the ears when bathing or showering. No diving or swimming activities in the meantime until the eardrum is completely healed.
  • Do not blow your nose. Blowing your nose can suddenly increase air pressure in the middle ear, causing damage to the healing eardrum.

Regularly visit the doctor to have your affected ear checked to see if there is progressive healing to your eardrum.

8 Risks and Complications

There are several risks and complications associated with ruptured eardrum.

The eardrum is part of the mechanism that transforms sound waves into nerve impulses to make hearing possible. Your eardrum also acts as a barrier to protect the middle and inner ear from water, bacteria and foreign substances in the outside environment.

Ruptured eardrums cause loss of hearing. The severity of hearing loss depends on the size of the hole and its location in the eardrum. Usually, the hearing loss is temporary until the eardrum is healed.

Because the eardrums cover the inner ear, ruptured eardrum can result in infection of the deeper parts of the ear. This can lead to more serious problems and even irreversible hearing loss.

Also, a hole or tear in the eardrum can allow earwax to enter the middle ear and form a cyst called cholesteatoma. This cyst attracts bacteria and result to an infection that damages inner parts of the ear.