Ruptured eardrum

What is a ruptured eardrum?

A ruptured eardrum, also called a tympanic membrane perforation, is a hole in the eardrum.

What causes it?

There can be many causes for a ruptured eardrum. Trauma from exposure of the ear to a loud blast, or a slap to the ear with a cupped hand, and rapid changes in pressure can result in a hole in the eardrum.  If a sharp object, like a Q-tip, is put too far into the ear canal it can cause a rupture. Middle ear infections can lead to ruptures. The hole can also be a result of a weakened area of the eardrum from a cholesteatoma, or a skin cyst of the ear. Chronic buildup of pressure in the ear, also called Eustachian tube dysfunction, can also lead to a hole. Eardrums that had ear tubes can leave behind a perforation. 

Why is it a concern?

A ruptured eardrum can cause some hearing loss. It can also make a person more susceptible to ear drainage and ear infections as it allows a path for water and bacteria to enter the middle ear, especially when exposed to water during swimming or bathing.  Sometimes, the size of the hole in the eardrum is fixed, but sometimes it can grow with time and lead to a larger amount of hearing loss. Eardrum holes are also at risk for causing skin cysts (cholesteatomas), at the edge of the hole.

How do we evaluate it?

An evaluation begins with an examination by an Ear, Nose and Throat doctor (Otolaryngologist). The doctor will likely use a microscope to further evaluate the rupture or hole. A hearing test is useful to assess the level of hearing loss.

How is it treated?

Some small ruptures of the eardrum may heal on their own with time. Other small holes may heal with placement of a paper patch over the hole, allowing for the skin cells to cross over the paper and seal the perforation. Larger holes may require surgery, especially if they are causing significant hearing loss or recurrent ear drainage and infections. Surgery entails grafting tissue from around the ear to patch the hole.

What is the long term outlook?

The long term outlook of eardrum rupture is very good, as many of them heal well on their own or with surgery, and hearing loss or recurrent infections can improve.