KEY TAKEAWAYS
- A hole or tear in the eardrum may be caused by an ear infection, a loud noise, a sudden change in pressure, or an injury to the ear.
- Most of the time, a small hole in the eardrum will heal on its own. This usually takes a few weeks to two months.
- It is crucial to keep your ear dry. Do not put anything into your ear, not even cotton buds or ear drops, unless your doctor tells you to.
- See a doctor if you notice hearing loss, fluid coming from your ear, strong pain, dizziness, or if your symptoms do not go away.
Have you ever felt a sudden sharp pain in your ear, only to notice that your hearing sounds muffled afterwards? Or perhaps you noticed fluid coming from your ear and wondered whether something had gone wrong inside.
It can be unsettling, especially when you hear the words “ruptured eardrum.” But a perforated eardrum is not always as serious as it sounds. In many cases, a small tear in the eardrum can heal naturally with time and proper care.
A perforated eardrum means there is a hole or tear in the thin layer that separates the ear canal from the middle ear. This can happen if you have an ear infection, hurt your ear, are exposed to a loud noise, or if the air pressure changes quickly.
Even though many eardrum holes heal by themselves, it is still a good idea to have your ear checked by a doctor, especially if you have hearing loss, fluid coming from your ear, strong pain, or dizziness. A specialist can find out how big the hole is, what caused it, and if you need treatment or just time to heal. So, what causes a perforated eardrum, and how do you know whether yours will heal on its own? Let’s take a closer look.
How Does the Eardrum Work?
The eardrum is a thin layer that sits between the outer ear and the middle ear. When sound enters your ear, it travels down the ear canal and makes the eardrum vibrate. These vibrations move through three small bones in your ear:
- Malleus, also called the hammer
- Incus, also called the anvil
- Stapes, also called the stirrup
The vibrations then reach the inner ear, where they are turned into signals that your brain understands as sound. If there is a hole in the eardrum, it may not vibrate as well as it should. This can make it harder to hear clearly. An opening in the eardrum can also let water and microorganisms into the middle ear, increasing the risk of infection.
What Causes a Perforated Eardrum?
A hole in the eardrum can happen for different reasons, including certain injuries or health problems.
Middle Ear Infection
A middle ear infection can make fluid and pressure build up behind the eardrum. Sometimes, this pressure gets so strong that it causes the eardrum to tear.
If the eardrum breaks, fluid or pus might start to drain out of the ear. The ear might actually hurt less after this happens because the pressure has been released.
A doctor should assess persistent or recurrent discharge. Recurrent infection associated with a perforated eardrum may require ENT assessment and, in some cases, surgical reconstruction of the eardrum.
Sudden Changes in Air Pressure
A quick change in pressure inside and outside the ear can hurt the eardrum. This is called barotrauma.
It can occur during:
- Air travel, particularly during ascent or descent
- Scuba diving
- Rapid changes in altitude
- Exposure to an explosive blast
- A direct blow to the ear
The Eustachian tube helps keep the pressure in your ear balanced. If it cannot do this, the pressure can build up and harm the eardrum.
Loud Noise
Very loud or sudden noises can hurt the ear and, if strong enough, can even cause a hole in the eardrum.
Explosions and other very loud sounds can also harm the inside parts of the ear. So, if you have trouble hearing after being around loud noise, it might not just be the eardrum that is affected.
Ear or Head Trauma
Getting hit on the ear or having a serious head injury can also cause a hole in the eardrum.
Trauma may also damage the small bones of the middle ear or other structures involved in hearing. Hearing loss, tinnitus or dizziness following an injury should therefore be assessed rather than assumed to be caused by the eardrum alone.
Objects Inserted Into the Ear
Putting things into your ear can hurt the eardrum directly. Cotton buds, hairpins and other objects can penetrate too deeply and create a perforation.
What Are the Symptoms of a Perforated Eardrum?
The symptoms you notice can depend on what caused the hole in your eardrum and the size. Possible symptoms include:
- Ear pain or discomfort
- Reduced hearing
- Ringing or buzzing in the ear, known as tinnitus
- Fluid or pus draining from the ear
- Blood coming from the ear
- Dizziness or vertigo
A hole in the eardrum can happen suddenly if you have an ear infection, get hurt, or if the pressure changes quickly. Hearing loss is an important symptom to watch for. A hole in the eardrum can make it harder for sound to travel through your ear. If the inner ear is also hurt, it can cause other hearing problems. Tinnitus may also occur. Singapore’s Ministry of Health notes that eardrum perforation is one of the possible pathological causes of tinnitus.
Can a Perforated Eardrum Heal on Its Own?
Yes. In many cases, a hole in the eardrum can heal on its own without surgery. How long it takes to heal depends on how big the hole is, where it is, what caused it, and if there is an infection or other damage.
A small perforation may close over several weeks. If the perforation remains open, however, an ENT specialist may need to assess whether further treatment is appropriate. Even though a hole in the eardrum can heal by itself, you should not try to treat it on your own. A doctor can check if your eardrum is really torn and see if you have an infection or hearing loss.
How Is a Perforated Eardrum Diagnosed?
A doctor will usually look inside your ear with a special light called an otoscope. This helps them see your eardrum and ear canal. A hearing test, or audiogram, may also be recommended if hearing is affected.
Diagnosis involves an otoscopic examination and that an audiogram is often necessary when assessing ear conditions involving perforation and hearing loss. If there are signs of more serious ear problems or other issues, the doctor may need to do more tests.
How Is a Perforated Eardrum Treated?
Treatment depends on the cause, size, and persistence of the perforation, as well as whether infection or hearing loss is present.
Observation
If the perforation is recent, small, and uncomplicated, a doctor may recommend observation while the eardrum heals naturally. Keep the ear dry during healing to reduce the risk of infection.
Treatment for Infection
When a perforation is associated with an ear infection, treatment may include appropriate antibiotics or topical medication prescribed by a doctor.
Not every perforated eardrum requires antibiotics. Treatment depends on the clinical findings and whether infection is present.
Do not use over-the-counter ear drops unless a doctor has specifically recommended them, as not all ear medications are suitable when the eardrum is perforated.
Eardrum Repair
If the perforation persists, an ENT specialist may recommend a procedure to close the defect. The appropriate procedure depends on the individual patient’s condition.
How Should You Care for a Perforated Eardrum?
Protecting the ear while the eardrum heals is important. Your doctor may advise you to:
- Keep the affected ear dry
- Avoid swimming until the eardrum has healed or your doctor confirms that it is safe
- Avoid inserting cotton buds or other objects into the ear
- Avoid using ear drops unless prescribed or recommended
- Avoid exposing the ear to excessive noise
- Avoid forceful nose blowing
Keeping the ear dry is particularly important because water entering through a perforation may increase the risk of middle ear infection.
When Should You See a Doctor?
See a doctor if you have symptoms that might mean you have a perforated eardrum, especially after an ear infection, injury, loud noise, or a sudden change in pressure.
Get medical help right away if you notice any of these signs:
- Sudden or significant hearing loss
- Blood or fluid draining from the ear
- Persistent or severe ear pain
- Significant dizziness or vertigo
- Hearing changes after a head or ear injury
Singapore’s Ministry of Health recommends visiting a GP clinic or polyclinic for most health issues. Emergency departments are for serious problems like sudden severe pain, heavy bleeding, sudden severe dizziness, or other neurological symptoms.
Can a Perforated Eardrum Cause Permanent Hearing Loss?
A perforated eardrum does not always lead to permanent hearing loss. If the eardrum heals and there is no other damage, your hearing can return to normal. But if the hole does not heal, or if you have repeated ear infections, damage to the tiny ear bones, or inner ear injury, you might have lasting hearing problems.
Hearing loss associated with a perforated eardrum can sometimes occur alongside damage to the middle-ear ossicles, particularly in chronic ear disease. A hearing test can show how much hearing loss you have and if you need more treatment.
