Diagnosis

The diagnosis of a ruptured eardrum is made by its visual inspection. To do this, the doctor uses an ear funnel to look into the external auditory canal up to the eardrum and examine its structure. If a tear or hole is visible, the surrounding structures can provide clues as to the cause.

Strong secretion and redness would indicate an inflammation of the middle ear with effusion, and bleeding or traces of injury would indicate trauma. Of course, the anamnesis also makes it possible to clarify the cause. In divers, for example, ear endoscopy often confirms the suspected diagnosis of a ruptured eardrum.

Symptoms

The symptoms of a ruptured eardrum are very specific and can be easily diagnosed. Initially it hurts when the eardrum ruptures. Affected persons feel a sharp, short earache that seems unusually severe.

This is usually followed by a sudden onset of hearing loss, which can vary in severity depending on the size of the tear. The hearing loss lasts for a certain period of time and does not change in intensity on the first day. It only decreases as the eardrum heals and then disappears completely when the patient is fully recovered.

In the case of inflammatory ruptures, a secretion from the ear can be noticed which is either clear, purulent or bloody. The secretion is from an inflammation of the middle ear, which relieves its effusion via the outer ear. The inflammation may also be accompanied by fever or even an increased body temperature.

Finally, a feeling of dizziness is also possible, which is caused by the irritation of the inner ear. However, dizziness is only specific for a ruptured eardrum if it is present with at least one other symptom already mentioned. Dizziness alone is more likely to indicate other causes.

Treatment/Therapy

A ruptured eardrum is usually treated conservatively. Therefore, no manipulation of the eardrum is performed or an attempt is made to cover the defect. The background to this often wait-and-see attitude is that the eardrum can regenerate itself very well in the case of small tears.

Only cracks with frayed edges or very large cracks require splinting of the defect with silicone foil. If this method is not sufficient, the defect must be covered with the body’s own material, which is called myringoplasty in the technical terminology. Drugs are only used in cases of severe pain or a bacterial inflammation of the middle ear.Especially in the case of bacterial infections, the prescription of antibiotics is useful to inhibit the growth of the bacteria and thus support wound healing.

To prevent bacteria from entering the middle ear through a perforated eardrum, it is important to keep the ear dry and clean. Those affected must therefore seal their external auditory canal with absorbent cotton and avoid water entering the ear. Even when showering, absorbent cotton and careful handling of the shower spray should protect the affected ear from water ingress.

The moisture would be a perfect breeding ground for bacteria and only delay the healing of wounds. Surgery is only considered in rare cases for the treatment of a ruptured eardrum. If the eardrum does not heal on its own due to a defect that is too large or if tears occur excessively often, surgical treatment is a promising therapeutic option.

The operation can be seen as a rather minor surgical procedure that takes less than an hour on average and can be performed under local or general anesthesia. Cosmetically, only a small incision behind the ear is necessary, leaving an inconspicuous small scar. The aim of the procedure is to reconstruct the eardrum.

The material used is the body’s own structures such as the fascia of the temporal muscle or a tight layer of connective tissue from the auricle. The advantage of the body’s own material is that it is not rejected by the body when it is implanted in the ear as a tympanic membrane. In addition, the removed material is very elastic and yet taut, ensuring good function.

During the procedure, the functionality of the ossicular chain can also be assessed and, if necessary, damage can be repaired. Depending on the degree of ossicular impairment, the surgery is divided into four types. Depending on the type, the surgeon corrects more or less parts of the ossicles and anchors them with the new eardrum.

Relatively little pain is expected after the operation. For the patients, tamponing of the affected ear is more likely to be uncomfortable, which will affect hearing. However, it is essential for the wound to heal and must remain in the ear canal for about three weeks. After all, the success rate for a successful closure of the eardrum is 95%.