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Perforated eardrum

Introduction

A perforated eardrum is a hole or tear in your eardrum.  It may 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.

If you have a perforated eardrum, avoid getting your ear wet and take painkillers as required. Surgery may be necessary in severe cases. Read more about treating a perforated eardrum.

If you have a perforated eardrum, your hearing will probably be affected and you will have earache. Any hearing loss is usually temporary. Read more about the symptoms of a perforated eardrum.

There are several possible causes of a perforated eardrum. The most common cause is an infection of the middle ear. It can also be caused by a loud noise or injury to the ear.

When to get medical help

See your GP if you have pain or discomfort in your ear for more than a couple of days.

The Ear

Your ears consist of  three parts:

  • the outer ear
  • middle ear
  • inner ear

The outer ear is made up of the visible part of the ear (pinna) on the side of your head, the ear canal that goes into your head, and the eardrum.

The middle ear is a small, air-filled cavity, connected to the nose and throat by the eustachian tube. Inside the middle ear there are three small bones, known as the ossicles.

The inner ear is made up of:

  • a coiled, spiral tube (the cochlea) that contains two fluid-filled chambers
  • a nerve that transmits sounds to the brain (auditory nerve)

What does the eardrum do?

The eardrum helps you to hear.  Sound waves enter your ear and make your eardrum vibrate. These vibrations then pass from your eardrum through the small bones (ossicles) inside your middle ear.The ossicles amplify the vibrations and pass them on to the inner ear.

The cochlea in your inner ear contains tiny hair cells that move in response to the vibrations passed from the middle ear. The movement of the hair cells generates an electrical signal that is transmitted to the brain along the auditory nerve. 

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Symptoms

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:

  • earache or discomfort
  • discharge of mucus from your ear
  • buzzing or ringing in your ear (tinnitus)

Risk of infection

The eardrum forms a protective barrier that prevents germs and bacteria from entering your middle ear. Therefore, if you have a perforated eardrum your risk of developing an ear infection is increased.

If you have an infection of the middle ear, your symptoms may include:

  • severe earache, due to the pressure of the mucus on the eardrum
  • a high temperature (fever) of 38C (100.4F) 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 (38C or above)
  • irritability
  • poor feeding
  • restlessness at night
  • coughing
  • runny nose
  • not responding to quiet sounds
  • loss of balance 
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Causes

There are a number of causes of a perforated eardrum.

Middle ear infection

An infection of the middle ear (otitis media) 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 ruptures (bursts), allowing the pus to escape. This mucus discharge is a common symptom of a perforated eardrum.

Injury

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.

Loud noises

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 that is caused by a loud noise will often cause severe hearing loss and tinnitus (ringing in the ears).

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 occurs because there is a big difference between the air pressure outside the ear and the air pressure inside the middle ear.

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Diagnosis

If you have pain or discomfort in your ear for more than a couple of days, you should see your GP.

Examining your eardrum

Your GP will examine your ears with an auriscope, also known as an otoscope.

An auriscope is an instrument with a light and a lense that allows your GP to examine the inside of your ear.

If your eardrum is perforated, your GP will be able to see a hole or tear in your eardrum.

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Treatment

In many cases a perforated eardrum should heal by itself without treatment within around two months. If treatment is needed, it's mainly to relieve discomfort and treat infection.

Painkillers

In the meantime, you can relieve any pain by taking painkillers such as paracetamol or ibuprofen. Never give aspirin to children under 16.

In some cases ibuprofen is not recommended, such as if you have had a peptic ulcer. It can also cause side effects.

Warming your ear with a hot water bottle wrapped in a towel may also relieve discomfort.

Antibiotics

If your perforated eardrum is caused by an infection, or if there is a risk that an infection will develop while your eardrum heals your GP may prescribe antibiotics. You may be prescribed antibiotic eardrops or tablets to be swallowed.

Surgery

You may need surgery if your perforated eardrum is severe or doesn’t heal. The procedure used to repair a perforated eardrum is called 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 your GP refers you to a consultant for specialist treatment, such as surgery, you should have a referral to treatment time which is no longer than 26 weeks.

Read more about NHS waiting times for treatment.

The procedure

If you decide to have a myringoplasty, you will be admitted to the specialist ear, nose and throat (ENT) department of your local hospital. The time you will spend in hospital varies from a few hours to two days, depending on your circumstances.

You will be under general anaesthetic when the surgery is carried out, so you will be asleep throughout the procedure. It usually takes an hour or two.  A small piece of tissue will usually be taken from above your ear and is used to seal up the hole in your eardrum. This is called a graft.

Then, the surgeon will use a microscope and very small surgical equipment to seal up the hole with the skin graft. Sometimes, they may make an incision behind the ear so they can access your eardrum more easily.

After the operation, a dressing will be put 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.

Recovery

You will need two weeks off school or work after your operation. During this time, you should avoid:

  • sudden head movement
  • contact sports or strenuous exercise
  • heavy lifting
  • people who have a cough or cold, so that you don’t catch their infection

A myringoplasty should not cause too much pain, but if necessary you can take painkillers, such as paracetamol. You may experience some dizziness for two or three weeks.

You will have to return to the outpatient clinic at the hospital two to four weeks after the operation to have your dressings removed, and to have your ears checked. If you have had stitches, you may have to return earlier (after around a week) to have them removed.

You should keep any wounds dry until they have healed, and keep your ear dry. You should also avoid 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. 

Avoid getting water in your ear

While your eardrum is healing, you should avoid getting water inside it. Wear a shower cap over your ears, or gently place a cotton wool ball in the affected ear while you shower. Do not go swimming while your eardrum is healing.

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Complications

Before you have surgery to repair a perforated eardrum (myringoplasty), discuss it with your surgeon. They can tell you about any problems you may have as a result of the procedure.

Complications associated with a myringoplasty are rare, but may include those below.

Infection

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 GP if you think you may have an infection.

Hearing loss

Severe deafness can occur if your inner ear is damaged during surgery, although this is very rare.

Read more about hearing loss.

Tinnitus

Following surgery, you may experience ringing or buzzing in your ear, known as tinnitus.

Dizziness

It is common to experience dizziness for a few hours after surgery. In a small number of cases, the dizziness can last for longer.

Facial paralysis

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.

Taste

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.

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Frequently asked Questions

Is it safe to fly with a perforated eardrum?

Yes. In fact, flying with a perforated eardrum should actually cause you less discomfort than if your eardrum is intact.

How your eardrum works

Your eardrum is a small, circular membrane that is covered in a thick layer of skin, and it is located between the outer and middle ear. A perforated eardrum is a hole, or tear, in your eardrum.

When you have a perforation (hole) in your eardrum, the air pressure in your middle ear and in the surrounding air should be able to balance out more easily. This is because the air is able to pass through the hole.

When your eardrum is intact, air can only pass into, or out of, your middle ear through the eustachian tube which connects your middle ear to the back of your nose and throat. The eustachian tube is closed most of the time and usually only opens when you yawn, or swallow.

Flying

When a plane takes off, the pressure inside the cabin drops. This means that the air in your middle ear is at a higher pressure than the pressure inside the cabin. This does not usually cause a problem (whether your eardrum is perforated or not) because the air is forced down the eustachian tube, and the pressure evens out.

When a plane lands, the pressure of the air in your middle ear is lower than in the plane, and the eustachian tube can become blocked. The low pressure in your middle ear can cause your eardrum to press inwards, which can cause discomfort and temporary hearing loss. However, after a short while, this usually returns to normal by itself.

If you have a perforation (hole) in your eardrum, the air should move into and out of your middle ear more freely because it does not need to rely on the eustachian tube to let air pass in and out. Therefore, you should not experience as much discomfort.

If you have a perforated eardrum, you should keep your ear dry in order to avoid infection. Do not go swimming, or diving, and be careful not to get water in your ear in the shower.

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