PERFORATED EARDRUM

A perforated eardrum is a hole, rupture or tear in the tympanic membrane, commonly called the eardrum, which separates the ear canal and the middle ear. A decreased ability to hear and an occasional discharge often accompany a perforated eardrum. Any associated pain is usually not persistent.

Causes

Physical trauma, exposure to very loud noise, infection, or medical procedures are all possible causes of a perforated eardrum. The membrane may be ruptured as the result of a blow to the ear with a flat surface such as an open hand. Accidents while diving or water skiing, pressure changes from flying or scuba diving, or skull fractures can cause a ruptured eardrum. When harmful substances — such as acid or the hot slag produced by welding — enter the ear canal, the eardrum may be perforated. Bobby pins, cotton swabs or other objects pushed too far into the ear canal can perforate the eardrum. Being exposed to sudden explosions can cause the eardrum to rupture. Middle ear infections can cause a spontaneous tear in the eardrum. The perforation may be caused by a small hole remaining in the eardrum after a pressure-equalizing tube has been placed and subsequently either falls out or is removed by a physician.

The amount of hearing loss is usually related to the size of the perforation and its location in the eardrum. In the case of a severe skull fracture, hearing loss may be severe if, in addition to the perforated eardrum, the sound-transmitting bones in the middle ear are disrupted or inner ear structures are injured. In cases of physical trauma or an explosion, the hearing may be significantly impaired, and ringing in the ears can be severe, although hearing is usually partially restored and the ringing diminishes within a few days. If the perforation results in chronic infection, hearing impairment may be severe.

Treatment

A physician should be consulted if a perforated eardrum is suspected; he or she can diagnose the condition and recommend the appropriate treatment. A hearing test is generally performed before attempts are made to correct the perforation. When the perforation is very small, the physician often observes the condition over a period of time before beginning treatment. Most perforations of the eardrum will heal on their own, usually within a few weeks but possibly over several months. While the eardrum is healing, it must be protected from exposure to water and trauma. The doctor may also patch the eardrum during an office procedure performed with an instrument that resembles a microscope. The doctor places a chemical on the edges of the perforation and then puts a thin paper patch on the eardrum. Patching the eardrum in this way usually noticeably improves hearing. Some perforations may require three or four patchings before the rupture is completely closed. If the paper patch is not deemed a suitable course of treatment or if it proves ineffective, another surgical procedure will probably be recommended by the doctor.

Surgery to repair a perforated eardrum is called tympanoplasty. The procedure, done on an outpatient basis, involves placing tissue across the perforation to allow healing. This type of surgery is usually successful in closing the perforation and improving hearing.