Brief overview
- Treatment: Often a tympanic membrane perforation heals on its own within a few days; larger injuries are operated on
- Symptoms: In case of rupture due to inflammation of the middle ear, among others, discharge, decrease of pain, in case of injury stabbing pain, hearing loss, blood discharge from the ear possible
- Causes and risk factors: Rupture due to inflammation of the middle ear, direct injury by objects or indirect injury by sudden change in pressure
- Diagnosis: Visual examination with an otoscope, hearing test
- Prognosis: Usually good prognosis for minor injuries, after surgery for major injuries, prognosis depends on severity of injury
- Prevention: Among other things, decongestant medications for middle ear infections, good pressure equalization when diving, flying or mountain climbing
What is a perforated eardrum?
This amplifies the sound waves and transmits them to the inner ear, where they are converted into nerve impulses. The brain eventually processes these signals and we perceive them as sounds and tones.
If the eardrum is ruptured or torn (i.e. perforated), this impairs the conversion and transmission of sound waves. Affected persons hear worse in the corresponding ear with the eardrum perforation (eardrum rupture) as a result. A tympanic membrane injury usually occurs on one side only, but – depending on the cause – is also possible on both sides.
A distinction is made between direct and indirect injuries. Direct injuries are those in which the eardrum is injured by objects such as cotton swabs, needles or flying splinters. In the case of indirect ones, the injury is usually caused by sudden changes in pressure, such as during explosions, rapid climbing or sinking in an airplane, or diving (too quickly) without equalizing pressure.
How can it be treated?
The eardrum has a high self-healing tendency. Even with multiple ruptures of the eardrum, it often heals without medical assistance. Especially if the hole is not at the edge but in the middle of the eardrum, the perforation usually heals without consequences. The healing time for minor eardrum damage is often only a few days.
If the eardrum is ruptured because of an accident or fall, or if the eardrum rim is injured, the eardrum usually does not heal as well. In the case of rim injuries, it is also possible for the skin to grow from the ear canal into the middle ear, interfering with the ossicles. This leads to further infection and prevents inflammation from healing.
There is a risk that the inflammation will spread to the organ of balance or the meninges. In such a case, surgery is essential. In the case of direct injuries, it is possible that, for example, the ossicles or other structures in the inner ear are injured.
In children who frequently suffer from acute middle ear infections, decongestant nasal drops are used to improve ventilation of the middle ear. This often prevents perforation of the eardrum. Severe middle ear infections are treated with antibiotics. However, antibiotics are not necessary for every middle ear infection.
Because a ruptured eardrum is a portal for germs to enter the ear, water sports should be avoided if there is a hole in the ear. Traveling by plane, on the other hand, is no problem – pressure equalization during takeoff and landing works even with a ruptured eardrum.
What are the symptoms?
A ruptured eardrum is not necessarily bad. A middle ear infection, for example, often heals faster once the eardrum is ruptured. Symptoms then include pus flowing out of the ear and hearing loss, but little or no pain. In fact, it is more likely that the pain previously caused by increased pressure in the middle ear will subside. The hole in the eardrum is usually small and causes only mild hearing loss because the eardrum still acts sufficiently as a sound amplifier.
With such extensive damage to the eardrum and ossicles, the damage does not heal on its own, and a lifetime of severe hearing loss is to be expected. Surgery is then the only option to avoid losing hearing forever.
Perforated eardrum: complications
The eardrum is a natural barrier to pathogens. If an eardrum perforation exists, pathogens enter the middle ear more easily, possibly triggering infections or making it more difficult for existing inflammations to heal.
Causes and risk factors
Tympanic membrane perforation usually happens as part of an inflammation or a violent impact on the ear. In addition, there are some risk factors that promote a hole in the eardrum.
Tympanic membrane perforation in middle ear inflammation
Eardrum perforation often occurs in association with middle ear infection. The inflammatory process causes the eardrum to lose stability, and it is also under tension due to the increase in pressure in the middle ear and has poorer blood supply. Middle ear infections occur acutely or chronically.
In most cases, however, it does not come to that. Acute middle ear infections usually subside after a few days, without the need to take medication or to discharge pus from the ear.
In rare cases, an acute middle ear infection also becomes chronic. The inflammatory process then lasts for a few weeks or even longer and almost always causes a hole in the eardrum.
If the effusion in the middle ear does not drain sufficiently, it is possible to insert an artificial eardrum hole (tympanostomy tube) into the eardrum. Due to the improved ventilation, the inflammation heals faster and further complications can be prevented. After a few months, the eardrum closes by itself and the small plastic tube falls out. A perforation of the eardrum may thus protect the ear from a more severe inflammation or destruction of the ossicles.
Eardrum perforation due to trauma
Some people try to clean the ear canal with cotton swabs. Since manipulation in the ear carries the risk of perforating the eardrum, doctors generally advise against cleaning the ear canal with cotton swabs. In addition, earwax is often just pushed deeper into the ear canal or small injuries promote inflammation of the ear canal.
Examinations and diagnosis
The ENT physician looks at the eardrum with the help of an otoscope, a small lamp with a plastic attachment, which he inserts into the ear canal. If the eardrum is ruptured or irritated by an inflammation, this can usually be detected.
In addition, the doctor will often use a small balloon to change the pressure conditions in the ear canal and thus observe the eardrum as it moves. This is important, for example, in the case of chronic inflammation or as a check during the healing of an eardrum perforation.
Even though many people find the examination unpleasant, looking directly into the ear with the otoscope is the easiest and quickest way to detect a hole in the ear or a middle ear infection.
Course of the disease and prognosis
The course of the disease and the prognosis for tympanic membrane perforations are usually good. Due to the high self-healing tendency, medical intervention is not even necessary. Hearing usually does not suffer any lasting damage.
In accidents or impact injuries with eardrum perforation, the course is often different. Depending on how badly the eardrum is injured, the ENT physician may have to operate on the eardrum. Especially if the ossicles are also damaged, long-term hearing loss in the affected ear is possible and often unavoidable.
Prevention
In the case of frequent or chronic middle ear infections, one tries to prevent a rupture of the eardrum with decongestant nasal drops, for example. These also decongest the mucous membrane of the Eustachian tube.
To prevent an injury caused by the change in pressure when diving, flying or mountain climbing, it is important to equalize the pressure gradually and well.
