Overview
A ruptured eardrum (also known as a perforated eardrum) is a condition in which a hole or tear occurs in the thin tissue that separates the ear canal from the middle ear. This tissue, known as the eardrum, plays a crucial role in hearing and protecting the middle ear from foreign substances. When the eardrum ruptures, it can result in hearing loss, mucus-like or pus-filled drainage from the ear, and in some cases, vertigo, nausea, or vomiting. Ruptured eardrums usually heal on their own within a few weeks without treatment, but sometimes they may require a patch or surgical repair to heal properly. Common causes include foreign objects in the ear, severe head trauma, and sudden changes in air pressure. Complications may include temporary or permanent hearing loss, middle ear infections, and the development of a middle ear cyst (cholesteatoma).
Understanding the disease
Symptoms
Symptoms of a ruptured eardrum can include:
- Ear pain, which may subside quickly
- Mucus-like, pus-filled, or bloody drainage from the ear
- Hearing loss
- Ringing in the ear (tinnitus)
- Spinning sensation (vertigo)
- Nausea or vomiting that can result from vertigo It is important to see a healthcare provider if you experience any of these symptoms, as ruptured eardrums can lead to complications if left untreated.
Risk Factors
Risk factors for developing a ruptured eardrum include:
- Small eustachian tube, especially in infants and toddlers
- The common cold
- Sinus infection
- Hay fever (allergic rhinitis)
- Middle ear infection (otitis media)
- Sleeping on an airplane during ascent and descent Additionally, activities such as scuba diving, hyperbaric oxygen chambers, and exposure to explosions nearby, such as in a war zone, can also cause a ruptured eardrum.
Development
A ruptured eardrum can develop in several ways:
- Hearing loss: Hearing loss can cause the eardrum to rupture due to the pressure created by sound waves.
- Middle ear infection (otitis media): A middle ear infection can cause the eardrum to rupture due to the accumulation of fluids in the middle ear.
- Foreign objects in the ear: Small objects, such as cotton swabs or hairpins, can puncture or tear the eardrum.
- Severe head trauma: Severe injury, such as a skull base fracture, can dislocate or damage middle and inner ear structures, including the eardrum.
- Loud sounds or blasts (acoustic trauma): A loud sound or blast can rarely cause a tear in the eardrum.
- Barotrauma: Stress exerted on the eardrum due to pressure differences between the middle ear and the environment can cause the eardrum to rupture. This can occur during air travel, scuba diving, or a direct blow to the ear, such as an automobile air bag impact.
Assessment and Diagnosis
Triage
If you suspect a ruptured eardrum, you should see a doctor when you observe any of the symptoms listed: ear pain that may subside quickly, mucuslike, pus-filled, or bloody drainage from the ear, hearing loss, ringing in the ear (tinnitus), spinning sensation (vertigo), or nausea or vomiting that can result from vertigo. It is important to have a healthcare provider evaluate the cause of your ear symptoms and determine if a ruptured eardrum has occurred.
Diagnosis
A provider or an ENT specialist can diagnose a ruptured (perforated) eardrum through visual inspection using a lighted instrument (otoscope or microscope). Additional tests may include laboratory tests to detect a bacterial infection, tuning fork evaluation to assess hearing loss, tympanometry to indicate a perforated eardrum, and an audiology exam to measure hearing sensitivity.
Management and Treatment
Complications
Possible complications of a ruptured eardrum include hearing loss, which is usually temporary, and middle ear infections (otitis media). If the perforated eardrum doesn't heal, a small number of people may be vulnerable to ongoing or recurrent infections, leading to chronic drainage and hearing loss. Another rare complication is the development of a middle ear cyst (cholesteatoma), which can damage the bones of the middle ear.
Treatment
Treatment for a ruptured eardrum usually involves allowing the ear to heal on its own. The body naturally creates fluid to fill the space behind the eardrum, which helps to equalize pressure and promotes healing. In most cases, a ruptured eardrum will heal within a few weeks without specific treatment. However, if the rupture is large or causing significant symptoms, a healthcare provider may recommend one of the following treatments:
- Watchful waiting: In cases where the rupture is small and causing minimal discomfort, your healthcare provider may recommend monitoring the condition without any intervention.
- Ear drops: Antibiotic ear drops may be prescribed if there is an underlying infection, such as otitis media. These drops can help reduce inflammation and fight bacterial infections.
- Pain relief: Over-the-counter pain relievers like acetaminophen or ibuprofen can help alleviate pain and discomfort associated with a ruptured eardrum.
- Surgical repair: In some cases, a ruptured eardrum may not heal on its own or may require surgical intervention. A healthcare provider may perform a myringoplasty, a surgical procedure to repair the eardrum. This is typically reserved for cases where the rupture is large or causing significant complications. It's essential to follow up with a healthcare provider for proper evaluation and guidance on the best course of treatment for a ruptured eardrum.
Preparing for medical consultation
To prepare for an appointment for a suspected ruptured eardrum, you should:
- Make a list of symptoms you're experiencing, including any that may seem unrelated to hearing loss, fluid discharge, or other ear-related symptoms.
- Note any relevant events that may be related to your ear problems, such as a history of ear infections, recent ear injuries or head traumas, or recent air travel.
- List any medications, including vitamins or supplements, you're taking.
- Prepare a list of questions to ask your provider, such as:
- Do I have a ruptured eardrum?
- What else could be causing my hearing loss and other symptoms?
- If I have a ruptured eardrum, what do I need to do to protect my ear during the healing process?
- What type of follow-up appointments will I need?
- At what point do we need to consider other treatments?
- Be prepared to answer your provider's questions about when your symptoms started, any previous symptoms that have cleared up, history of ear infections, exposure to loud sounds, recent swimming or diving, recent flying, history of head injuries, and any ear cleaning practices you may have. It's important to keep your ears dry and avoid swimming until your condition has been evaluated by your provider. Use a moldable, waterproof silicone earplug or a cotton ball coated with petroleum jelly to keep water out of the ear while showering or bathing. Avoid putting medication drops in the ear unless prescribed by your provider.