Ruptured Ear Drum Patient Information

What is the tympanic membrane (eardrum)?

The tympanic membrane (eardrum) is a thin membrane that separates the middle ear from the outer ear. It is composed of three layers, the ectoderm (skin), mesoderm (fibrous connective tissue), and endoderm (mucosa).

What are the functions of the eardrum?

The eardrum provides a barrier between the middle and the outer ear, preventing foreign bodies and microbes from entering the middle ear. When exposed to sound, the eardrum vibrates and converts sound energy to mechanical vibration into the inner ear (cochlea) via the ossicles in the middle ear (malleus, incus, and stapes). As a result, the eardrum serves a critical function in normal hearing and in preventing infections.

What is a tympanic membrane perforation (ruptured eardrum)?

A ruptured eardrum (tympanic membrane perforation) is a hole or a tear in the eardrum. A ruptured eardrum can occur as a result of trauma (explosion, Q-tip use, temporal bone fracture, etc.), an infection, or from an ear tube placement.

How does a ruptured eardrum typically present?

In all cases of a ruptured eardrum, hearing loss, ear drainage, and ear fullness are common symptoms. If the perforation is persistent and does not heal, then complications such as a chronic ear infection or development of a cholesteatoma (middle ear cyst) can occur with subsequent ear pain, pus drainage, and worsening hearing loss.

In cases of traumatic injury, ear pain and bloody discharge can be present initially and will usually improve, especially as the perforation is healing. In cases of an acute infection with a ruptured eardrum, patients may initially present with severe pain and bloody and purulent discharge. Once the ear begins to drain, the pain may be alleviated due to decompression of the pressure in the middle ear. In cases of chronic Eustachian tube dysfunction or cholesteatoma, patients may present with ear drainage and hearing loss without any significant discomfort.

What should you expect during your visit with your ENT doctor for a tympanic membrane perforation?

There are multiple causes of a ruptured eardrum (tympanic membrane perforation). During your visit, your ENT doctor will perform a complete history and physical exam to determine the exact cause of your ruptured eardrum. A hearing test, including an audiogram and tympanogram, is typically completed to establish a baseline hearing level and to evaluate the function of the eardrum. A procedure called otomicroscopy (examination of the ear using the microscope) is performed to closely evaluate the eardrum anatomy. If necessary, debris such as wax, skin, and pus will be removed from the ear during the procedure for better visualization. Depending on your history and examination, your physician may refer you to obtain additional studies including an ear culture and a radiographic exam to better evaluate for other diseases such as a cholesteatoma.

How is a ruptured eardrum treated?

Most traumatic tympanic membrane perforations and perforations from ear tube placement will heal spontaneously within a few weeks without any treatment. However, with a large perforation or a perforation with a concurrent infection, the hole may persist. In cases of an active infection, topical antibiotic drops may alleviate the inflammation and allow the drum to heal. Water precautions may be necessary to reduce the risks of recurrent infections. In cases of a chronic infection or underlying Eustachian tube dysfunction, the perforation may not heal until a surgical repair is completed.

When is surgery (myringoplasty or tympanoplasty) indicated?

Usually, close observation for 2-3 months is reasonable before surgery is recommended. Complications related to a chronic ruptured eardrum include hearing loss, ear infections, and cholesteatoma formation. As a result, surgical repair of the eardrum is usually recommended with a chronic perforation. With a small and easily accessible perforation, a paper patch or a myringotomy can be considered. A tympanoplasty is typically recommended for larger perforations that are difficult to access.

Learn more about repair of a ruptured eardrum (tympanoplasty) and post-operative care after a tympanoplasty.

Figure 4. Tympanic membrane perforation (left) & tympanoplasty (right). Source: Stanford.edu, Robert Jackler