Overview: What is a ruptured eardrum?
A ruptured eardrum is a small hole or tear in the eardrum that is located just in front of the middle ear when viewed from the outside. The eardrum ruptures quite suddenly, for example as part of a middle ear infection or due to a sudden increase in pressure in the ear canal (for example when diving). An injury in the ear area or improper cleaning of the ear or a violent blow to the ear can also rupture the eardrum.
The eardrum consists of an oval to circular membrane about one centimeter in diameter and is about 0.1 millimeter thin. It is located between the external auditory canal and a part of the middle ear called the tympanic cavity.
The eardrum fulfills two main functions: On the one hand, it is involved in sound transmission by transporting sound waves from the outside via vibrations. Secondly, the eardrum protects the middle ear from bacteria and other external pathogens. If the eardrum ruptures, this protective function is lost.
Rupture of the eardrum – frequency and duration
A ruptured eardrum can affect both children and adults. The exact incidence is not known because not all tympanic membrane ruptures are perceived as such by the affected person. Presumably, however, a ruptured eardrum is relatively common, especially in children, as they suffer more frequently from middle ear infections.
It usually takes only a few days to weeks for a ruptured eardrum to heal on its own. Until the final healing, affected persons should take strict care that no water enters the ear canal, as this increases the risk of infection.
Ruptured eardrum: Causes
The eardrum can rupture due to various causes. One of the most common causes is otitis media. When the middle ear is inflamed, pressure builds up due to the accumulation of fluid in the middle ear and presses against the eardrum. If the pressure becomes too great, the eardrum may be perforated and the fluid (e.g., pus) will leak out through the ear canal. In this case, it may happen that the pain and pressure felt by the affected person due to the infection will quickly improve.
Another common cause of a ruptured eardrum is an injury with a foreign object from the outside, such as a cotton swab while cleaning the ear. Sometimes children can puncture their own eardrums by putting objects like a small stick or toy in their ear.
In addition, a head injury or blow to the ear can also cause the eardrum to rupture. The same is true for massive acoustic trauma caused by sudden very loud noises, such as an explosion or a blown tire.
A ruptured eardrum can also be the result of what is known as barotrauma. This happens when the pressure outside the ear suddenly rises or falls and no longer matches the pressure inside the inner ear. This can happen, for example, if an aircraft suddenly changes altitude or if divers surface too quickly
Symptoms: A ruptured eardrum does not always lead to complaints
In many cases, a ruptured eardrum is not serious and, depending on the causes, results in only mild discomfort, if any. If a painful middle ear infection is the reason for the ruptured eardrum, sufferers may even experience pain relief from the perforation.
Some people do not notice any discomfort from a ruptured eardrum. Others go to the doctor only after several days of general discomfort in the ear and the feeling that “something is not quite right with the ear.” Some people are surprised to hear air coming out of their ear when they blow their nose. When you blow your nose vigorously, the air rises and fills the space in the middle ear. Normally, this causes the eardrum to bulge outward. However, if there is a hole in the eardrum, air will flow out. Sometimes the noise is so loud that other people can hear it.
Other possible symptoms of a ruptured eardrum include:
- sudden onset of ear pain or a sudden decrease in ear pain
- Discharge from the ear, which may be bloody or transparent or resemble pus
- Ringing in the ears
- Mild to complete hearing loss
Ruptured eardrum: Diagnosis with us
We usually make the diagnosis with the help of an otoscopy. An otoscope is an instrument with a light that is used to look inside the ear. In most cases, this enables us to detect a hole or tear in the eardrum. An even better overview is achieved with ear microscopy.
Sometimes there can be too much earwax or fluid, so we can’t see the eardrum clearly. If this is the case, we will clean the ear canal before diagnosis or prescribe ear drops that will help the affected person to clean the ear canal by themselves. In order to test the hearing ability, we can additionally perform a so-called tuning fork test or audiological test on the computer (sound audiometry).
In some cases, we also use imaging techniques such as magnetic resonance imaging or computed tomography to make the diagnosis.
Ruptured eardrum: Prevention & Prognosis
The two most important measures to prevent a ruptured eardrum are:
- Do not put any objects in the ear, even for cleaning purposes
- Treat ear infections immediately
In addition, it is important to see us to remove a foreign body from the ear rather than trying to remove it yourself.
The prognosis is generally very good. In 95 percent of cases, the ruptured eardrum heals on its own within a few days to weeks. Prolonged tympanic membrane ruptures increase the risk of chronic otitis media and hearing loss in children. In these rare cases, surgery of the eardrum may be necessary.
Ruptured eardrum: Treatment is rarely necessary
Usually, no special treatment is required for a ruptured eardrum. The vast majority of ruptured eardrums heal within a few days to weeks.
We may prescribe an antibiotic – either as a tablet or in the form of ear drops – for the patient to prevent an ear infection or to treat an existing infection. If the ruptured eardrum causes pain, we may also recommend taking an over-the-counter pain reliever such as acetaminophen or ibuprofen.
Until the eardrum is intact again, affected individuals should keep the ear dry. Swimming and diving should be avoided until we can confidently confirm that the eardrum has healed completely. In addition, affected individuals should wear a shower cap or use water-resistant earplugs when showering to prevent water from entering the ear.
If the eardrum is slow to heal, surgery may be required in some cases. The surgery is usually performed under anesthesia and lasts one to two hours. In this procedure, we insert a piece of the patient’s own tissue (cartilage or muscle skin) at the eardrum to reconstruct it completely.
In case of a surgical intervention, the Institute of Anesthesiology will select the anesthesia procedure that is individually adapted to you.