A perforation is a hole in the eardrum.
Eardrum perforations are caused by middle ear infections and injuries.
Perforation causes sudden ear pain, sometimes with bleeding from the ear, hearing loss, or noise in the ear.
Doctors can see the perforation with an otoscope.
Usually the eardrum heals on its own, but sometimes surgical repair is needed.
Causes
The eardrum may be perforated (punctured) by objects inserted in the ear, such as a cotton swab, or by objects entering the ear accidentally, such as a low-hanging twig or a thrown pencil. An object that penetrates the eardrum can dislocate or fracture the chain of small bones (ossicles) that connect the eardrum to the inner ear. Pieces of the broken ossicles or the object itself may penetrate the inner ear. A blocked eustachian tube, which connects the middle ear and the back of the nose, may result in a perforation because the air pressure on either side of the eardrum is very different (barotrauma).
The eardrum can also be perforated by a sudden change in pressure outside the eardrum:
An increase in pressure, such as that caused by an explosion, an open-handed slap, or diving underwater
A decrease in pressure, such as occurs while flying in an airplane or when strong suction is applied to the ear canal
A perforation may occur when doctors irrigate the ear canal or remove a foreign object.
Severe head injury may cause a perforation, particularly if the base of the skull near the ear is fractured.
A middle ear infection (otitis media) is the most common cause of eardrum perforation that is not related to an injury.
CLINICA CLAROS/SCIENCE PHOTO LIBRARY
Image provided by Piet van Hasselt, MD.
Symptoms of Eardrum Perforation
A middle ear infection (otitis media) severe enough to cause perforation is usually quite painful because of the buildup of infected fluid (pus). However, when the eardrum is perforated, pus can drain out of the ear, relieving the pressure and the pain.
Perforation of the eardrum by an injury causes sudden severe pain, sometimes followed by bleeding from the ear, hearing loss (conductive or sensorineural), and noise in the ear (tinnitus). Conductive hearing loss occurs when sound is blocked from reaching the sensory structures in the inner ear (for example, by disruption of the ossicles). Sensorineural hearing loss occurs when sound reaches the inner ear, but the sound cannot be translated into nerve impulses (for example, because of an inner ear injury) or nerve impulses are not carried to the brain. The hearing loss is more severe if the chain of ossicles has been disrupted or the inner ear has been injured.
Injury to the inner ear may also cause vertigo (a false sensation of moving or spinning). Pus may begin to drain from the ear in 24 to 48 hours, particularly if water or other foreign material enters the middle ear.
Diagnosis of Eardrum Perforation
A doctor's evaluation
A doctor diagnoses eardrum perforation by looking in the ear with a special instrument called an otoscope (a handheld light). If possible, formal hearing tests are done before and after treatment.
If hearing loss or vertigo is severe or if the perforation in the eardrum is large, people are evaluated by an otolaryngologist (a specialist in ear, nose, and throat disorders) as soon as possible.
Treatment of Eardrum Perforation
Antibiotics if needed
Sometimes surgery
The ear is kept dry. People are instructed to place a cotton ball lathered with petroleum jelly in the ear when they take a bath or shower to prevent water from getting in the ear. Swimming should be avoided.
Usually, no specific treatment is needed for eardrum perforation unless the injury was caused by a dirty object or if contaminants may have entered through the perforation. In such cases, doctors give antibiotic ear drops. Antibiotics may also be used if the ear becomes infected.
Usually, the eardrum heals without further treatment. If it does not heal within 2 months, surgery to repair the eardrum (tympanoplasty) may be needed. People with a severe injury, particularly one accompanied by marked hearing loss, severe vertigo, or both, may need to have more immediate surgery. If a perforation is not repaired, the person may develop a smoldering infection—chronic suppurative otitis media—in the middle ear.
A persistent conductive hearing loss occurring after perforation of the eardrum suggests disruption or immobility of the ossicles, which may be repaired surgically. A sensorineural hearing loss or vertigo that persists for more than a few hours after the injury suggests that something has injured or penetrated the inner ear.
