Ruptured eardrum

A ruptured eardrum or perforated or burst eardrum is a hole in the eardrum, which is a hole or tear in the thin tissue (tympanic membrane) that separates your ear canal from your middle ear (eardrum). If the hole is large then you may experience some hearing loss. A ruptured eardrum will usually heal within a few weeks and might not need any treatment. However, sometimes a ruptured eardrum requires a procedure or surgical repair to heal.

It’s a good idea to see your doctor if you think your eardrum has burst, as it can cause problems such as middle ear infections and injury. If you have an infection you should avoid getting water in the ear.

A ruptured eardrum can result in hearing loss.

Figure 1. Ear anatomy

What is ruptured eardrum healing time?

A ruptured eardrum will usually heal within a few weeks.

Is it safe to fly with a ruptured eardrum?

Yes, it is safe to fly with a ruptured (burst) eardrum. But if you’ve had surgery to repair a perforated eardrum (myringoplasty), you shouldn’t fly until your doctor or surgeon says it is safe to do so.

When you fly, the air pressure around you changes quickly, especially during take off and landing, which can cause pain or discomfort in your ear.

When you have a ruptured eardrum, the air pressure in your middle ear can balance out more easily with the pressure of the surrounding air, as the air is able to pass through the hole. This means flying with a ruptured eardrum may actually cause less discomfort than usual.

What causes a ruptured eardrum

Causes of a ruptured, or perforated, eardrum may include:

• Middle ear infection (otitis media). A middle ear infection often results in the accumulation of fluids in your middle ear. Pressure from these fluids can cause the eardrum to rupture.
• Barotrauma. Barotrauma is stress exerted on your eardrum when the air pressure in your middle ear and the air pressure in the environment are out of balance. If the pressure is severe, your eardrum can rupture. Barotrauma is most often caused by air pressure changes associated with air travel. Other events that can cause sudden changes in pressure — and possibly a ruptured eardrum — include scuba diving and a direct blow to the ear, such as the impact of an automobile air bag.
• Loud sounds or blasts (acoustic trauma). A loud sound or blast, as from an explosion or gunshot — essentially an overpowering sound wave — can cause a tear in your eardrum.
• Foreign objects in your ear. Small objects, such as a cotton swab or hairpin, can puncture or tear the eardrum.
• Severe head trauma. Severe injury, such as skull fracture, may cause the dislocation or damage to middle and inner ear structures, including your eardrum.

Ruptured eardrum prevention

Follow these tips to avoid a ruptured or perforated eardrum:

• Get treatment for middle ear infections. Be aware of the signs and symptoms of middle ear infection, including earache, fever, nasal congestion and reduced hearing. Children with a middle ear infection often rub or pull on their ears. Seek prompt evaluation from your primary care doctor to prevent potential damage to the eardrum.
• Protect your ears during flight. If possible, don’t fly if you have a cold or an active allergy that causes nasal or ear congestion. During takeoffs and landings, keep your ears clear with pressure-equalizing earplugs, yawning or chewing gum. Or use the Valsalva maneuver — gently blowing, as if blowing your nose, while pinching your nostrils and keeping your mouth closed. Don’t sleep during ascents and descents.
• Keep your ears free of foreign objects. Never attempt to dig out excess or hardened earwax with items such as a cotton swab, paper clip or hairpin. These items can easily tear or puncture your eardrum. Teach your children about the damage that can be done by putting foreign objects in their ears.
• Guard against excessive noise. Protect your ears from unnecessary damage by wearing protective earplugs or earmuffs in your workplace or during recreational activities if loud noise is present.

Ruptured eardrum signs and symptoms

Signs and symptoms of a ruptured eardrum may include:

• Ear pain that may subside quickly
• Itching in your ear
• Fluid leaking from your ear
• A high temperature (fever) of 100.4 °F (38 °C) or above
• Sudden hearing loss – you may find it difficult to hear anything or your hearing may just be slightly muffled
• Ringing or buzzing in your ear (tinnitus)
• Spinning sensation (vertigo)
• Nausea or vomiting that can result from vertigo

The symptoms will usually pass once your eardrum has healed and any infection has been treated.

Ruptured eardrum complications

Your eardrum (tympanic membrane) has two primary roles:

• Hearing. When sound waves strike it, your eardrum vibrates — the first step by which structures of your middle and inner ears translate sound waves into nerve impulses.
• Protection. Your eardrum also acts as a barrier, protecting your middle ear from water, bacteria and other foreign substances.

If your eardrum ruptures, complications can occur while your eardrum is healing or if it fails to heal. Possible complications include:

• Hearing loss. Usually, hearing loss is temporary, lasting only until the tear or hole in your eardrum has healed. The size and location of the tear can affect the degree of hearing loss.
• Middle ear infection (otitis media). A perforated eardrum can allow bacteria to enter your ear. If a perforated eardrum doesn’t heal or isn’t repaired, you may be vulnerable to ongoing (chronic) infections that can cause permanent hearing loss.
• Middle ear cyst (cholesteatoma). A cholesteatoma is a cyst in your middle ear composed of skin cells and other debris. Ear canal debris normally travels to your outer ear with the help of ear-protecting earwax. If your eardrum is ruptured, the skin debris can pass into your middle ear and form a cyst. A cholesteatoma provides a friendly environment for bacteria and contains proteins that can damage bones of your middle ear.

Ruptured eardrum diagnosis

Your family doctor or ENT specialist can often determine if you have a perforated eardrum with a visual inspection using a lighted instrument (otoscope).

Your doctor may conduct or order additional tests to determine the cause of the rupture or degree of damage. These tests include:

• Laboratory tests. If there’s discharge from your ear, your doctor may order a laboratory test or culture to detect a bacterial infection of your middle ear.
• Tuning fork evaluation. Tuning forks are two-pronged, metal instruments that produce sounds when struck. Simple tests with tuning forks can help your doctor detect hearing loss. A tuning fork evaluation may also reveal whether hearing loss is caused by damage to the vibrating parts of your middle ear (including your eardrum), damage to sensors or nerves of your inner ear, or damage to both.
• Tympanometry. A tympanometer uses a device inserted into your ear canal that measures the response of your eardrum to slight changes in air pressure. Certain patterns of response can indicate a perforated eardrum.
• Audiology exam. If other hearing tests are inconclusive, your doctor may order a series of strictly calibrated tests conducted in a soundproof booth that measure how well you hear sounds at different volumes and pitches (audiology exam).

Ruptured eardrum treatment

Most ruptured eardrums don’t always need to be treated because they often get better by themselves within a few weeks. Your doctor may prescribe antibiotic drops if there’s evidence of infection.

While it heals, the following tips can help you relieve your symptoms and reduce the chances of your ear becoming infected:

• don’t put anything in your ear, such as cotton buds or eardrops (unless your doctor recommends them)
• don’t get water in your ear – don’t go swimming and be extra careful when showering or washing your hair
• try not to blow your nose too hard, as this can damage your eardrum as it heals
• hold a warm flannel against your ear to help reduce any pain
• take painkillers such as paracetamol or ibuprofen to relieve pain if you need to (don’t give aspirin to children under 16)

If the tear or hole in your eardrum is large or doesn’t heal in a few weeks by itself, treatment will involve procedures to close the perforation. These may include:

• Eardrum patch. If the tear or hole in your eardrum doesn’t close on its own, an ENT specialist may seal it with a patch. With this office procedure, your ENT doctor may apply a chemical to the edges of the tear to stimulate growth and then apply a patch over the hole. The procedure may need to be repeated more than once before the hole closes.
• Surgery. If a patch doesn’t result in proper healing or your ENT doctor determines that the tear isn’t likely to heal with a patch, he or she may recommend surgery. The most common surgical procedure is called myringoplasty or tympanoplasty. Your surgeon grafts a tiny patch of your own tissue to close the hole in the eardrum. This procedure is done on an outpatient basis, meaning you can usually go home the same day unless medical anesthesia conditions require a longer hospital stay.

What happens during surgery for a ruptured eardrum

Surgery to repair a burst eardrum is usually carried out in hospital under general anesthetic (where you’re asleep).

During the procedure:

• a small cut is made just in front or behind your ear and a small piece of tissue is removed from under your skin – this will leave a small scar, which will usually be covered by your hair
• small surgical instruments are used to patch the hole in your eardrum with this piece of tissue – this may be done through your ear opening, or through a small cut made next to your ear
• a dressing is placed in your ear to hold the patch in place and stop water and germs getting in – this usually stays in place for about two or three weeks
• cotton wool padding is put over your ear and held in place with a bandage
• the cut(s) in your skin are closed with stitches

Most people can go home on the same day or the day after the operation.

Risks of surgery for a ruptured eardrum

Surgery to repair a ruptured eardrum doesn’t usually cause any serious problems.

But possible risks include:

• a wound infection, which can cause pain, bleeding and leaking of fluid – contact the hospital or your GP if you have these symptoms
• ringing or buzzing in your ear (tinnitus) – this usually improves in time, but can sometimes be permanent
• changes in taste – these are usually temporary, but can occasionally be permanent
• worse hearing or hearing loss – although permanent hearing loss is rare
• inability to move muscles in part of the face – this may get better over time, but can be permanent in rare cases

Before you have surgery, talk to your surgeon about the possible benefits and risks of the operation.

Recovering from surgery for a ruptured eardrum

It usually takes a few weeks for your eardrum to heal.

A follow-up appointment for about two or three weeks after your operation will be arranged before or soon after leaving hospital.

Looking after yourself

After the operation:

• make sure someone stays with you for the first 24 hours – don’t drive or drink alcohol during this time
• change the cotton wool in your ear every day (but leave the dressing that’s deeper in your ear in place)
• avoid getting your ear wet – place cotton wool covered in petroleum jelly (such as Vaseline) in your ear when showering
• you may need to stay off work (or school) for about a week – you might be off for longer if your job involves lots of moving or bending over
• after about a week, speak to your doctor about getting your stitches removed (if they don’t dissolve by themselves)

Activities to avoid

Until you’ve had your follow-up appointment, avoid:

• flying
• swimming
• smoking
• close contact with sick people – you could pick up an ear infection
• sports and other strenuous activities
• blowing your nose too hard – if you need to sneeze, try to keep your mouth open to reduce the pressure in your ear

Your doctor or nurse will advise you when to return to normal activities.

Ruptured eardrum home remedies

A ruptured eardrum usually heals on its own within weeks. In some cases, healing takes months. Until your doctor tells you that your ear is healed, protect it by doing the following:

• Keep your ear dry. Place a waterproof silicone earplug or cotton ball coated with petroleum jelly in your ear when showering or bathing.
• Refrain from cleaning your ears. Give your eardrum time to heal completely.
• Avoid blowing your nose. The pressure created when blowing your nose can damage your healing eardrum.