Perforated (ruptured) eardrum

What is a perforated eardrum?

A perforated or ruptured eardrum is a tear or hole in your eardrum which can cause ear infections and sudden hearing loss. If you experience any symptoms of a ruptured eardrum, we advise you to immediately contact your physician or a hearing health professional. If you are concerned about your hearing levels, contact Miracle-Ear for a consultation.

What does a ruptured eardrum feel like? Perforated eardrum symptoms

The most common symptoms of eardrum perforation are:

  • Sharp pain in the ear
  • Progressive hearing loss
  • Tinnitus (ringing in ears)
  • Itchy ears
  • Ear bleeding
  • Otorrhea: discharge of secretions from the ear
  • Ear infections

A perforation of the eardrum is a rupture of the membrane that transmits sound and separates the external auditory canal from the middle ear. However, the signs of eardrum rupture do not affect only the ears; other symptoms can include dizziness and vertigo, nausea and fever.

What causes a ruptured eardrum?

The eardrum is a very thin membrane that can be ruptured due to different causes, including:

  • Foreign bodies in the ear: Some objects, such as Q-tips or cotton swabs, can cause eardrum perforation.
  • Changes in air pressure (barotrauma): A sudden change in pressure, such as a change in altitude on an airplane, often causes ear pain. Occasionally, failure of the middle ear to compensate for ambient pressure can result in a rupture of the eardrum. This can also occur while scuba diving or in other situations where there is a large difference between the surrounding air pressure and the pressure within the middle ear.
  • Head trauma: Involves a fracture to the skull and can dislocate or damage structures in the middle and inner ear, including the eardrum
  • Middle ear infection (otitis media): This can cause the stagnation of secretions that press against the tympanic membrane until it breaks
  • Loud noises: A perforated eardrum can be caused by a sudden, very loud noise; for example, shock waves from a large explosion can damage sensitive parts of the ear, including the eardrum. Often, perforation of the eardrum caused by loud noise is from severe hearing loss and persistent ringing in the ears (tinnitus).
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Perforated eardrum diagnosis: Otoscopy and hearing tests

The first thing to do when you suspect a perforated eardrum is to undergo a visit to an ENT specialist - also called an otorhinolaryngologist - in which the specialist will define the diagnosis and the related treatment.

Diagnosis of eardrum perforation requires micro-otoscopy and an audiological examination, which evaluate the perforation and the hearing ability, respectively. During the otoscopic examination, the doctor uses the otoscope, an instrument with a light and a lens. This way, they can examine the ear and highlight any perforation of the eardrum, the site of the lesion and its size. The audiometric test evaluates the extent of the hearing loss.

Can a ruptured eardrum heal?

Generally, a ruptured eardrum heals on its own. The wound heals, and the pre-trauma hearing capacity recovers.

Perforated eardrums usually heal on their own within a couple of months. In the case of a minor lesion, the eardrum can heal spontaneously, even within a few weeks.

Until complete healing, it is essential to keep the ear dry. The eardrum prevents pathogens from reaching the middle ear; when it is perforated, the eardrum cannot perform this protective action, and the ear gets more exposed to infections. Therefore, it is necessary to prevent water from entering the ear when swimming at the beach or in swimming pools. While showering or swimming, it is important to wear an ear covering capable of preventing the entry of water or waterproof earplugs.
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Perforated eardrum treatments and medication

Treatments for perforated eardrums aim to relieve pain and treat or prevent an infection.

If necessary, the otolaryngologist can prescribe antibiotics in drops or oral pills to counteract an infection that has occurred after the perforation or as a treatment for otitis media. Painkillers, such as ibuprofen and acetaminophen, may be advised to keep ear pain under control.

In cases of extended eardrum perforation, recurrent ear infections or hearing loss, a microsurgical intervention for the reconstruction of the tympanic membrane may be necessary.

You may use antibiotics, but the ingredients in ear drops are especially recommended in case of a perforated eardrum, as they have a more targeted and effective local action with fewer side effects.

In some cases, you may require surgery to repair the eardrum rupture. Tympanoplasty is, like myringoplasty, a surgical procedure aimed at repairing a perforated eardrum.

Myringoplasty is performed under general anesthesia in day surgery or with a short hospitalization. Through the ear canal or by accessing the eardrum, with an incision behind the ear, the tympanic membrane is reconstructed using tissues taken from the same patient or biomaterials.

Recovery is about two weeks. For 15 days, the patient must rest and avoid sudden head movements. Until the postoperative follow-up visit, air travel and water in the ear must be avoided to prevent barotrauma and ear infections.

Tympanoplasty rarely has complications, but an infection may develop, and dizziness or tinnitus may occur. The most serious complications are hearing loss on the side undergoing surgery and facial paralysis or dysgeusia (altered perception of taste).

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What side should you sleep on with a ruptured eardrum?

If you have a ruptured eardrum in just one ear, sleep on the other side of your body to minimize pressure and reduce the risk of further damage. If both eardrums are ruptured, then back sleeping may be the most comfortable position until the ears heal, with your head elevated to a few inches.

Ruptured eardrums in children and toddlers

In children, perforation of the eardrum due to otitis media is very common. Eardrum rupture due to the insertion of foreign objects (ex: small toy components, cotton swabs) or barotrauma are also frequent. The most frequent symptoms are sudden and acute pain, hearing loss and tinnitus.

In children and toddlers, it is important to pay attention to some signs that could suggest the presence of an ear infection and perforation of the eardrum,  including: 

  • High fever
  • Balance problems and dizziness 
  • Itchy ears
  • Loss of appetite
  • Cold symptoms (mucus, coughing, stuffy nose, sore throat)
  • Pulling or tugging at the ears of infants

The pharmaceutical treatment prescribed by the pediatrician generally includes antibiotic therapy to fight infections and the administration of specific drugs to control pain and eliminate mucus. Children’s and adult ears must be kept strictly dry during the period of the infection.

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FAQs on perforated eardrums

A ruptured eardrum can often be painful, but pain isn't always a symptom. A deciding factor may be the underlying cause. For example, perforation of the eardrum due to trauma causes sudden severe pain, sometimes followed by ear bleeding, hearing loss, and tinnitus.

In some cases, a ruptured eardrum can cause sudden hearing loss. Usually, hearing loss is temporary and lasts until the eardrum rupture heals. If you do not recover your hearing after a couple of months, a microsurgical intervention for the reconstruction of the tympanic membrane may be needed.

In severe cases, blowing your nose too hard can cause an eardrum rupture.

The sensation of air coming out of the ear when blowing the nose could also be a symptom of a perforated eardrum. This happens because when you blow your nose forcefully, it causes air to move up into your middle ear, filling the space. But if there is a hole in the eardrum, air will rush out.

Finally, blowing the nose hard should be avoided while your perforated eardrum is healing, as this action can damage your eardrum from the inner side.

Yes, you can take a plane and fly with a perforated eardrum, as the perforation allows air to pass through and therefore does not complicate compensation.

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