Health Library

Tympanic Membrane Perforation (Ruptured Eardrum)

Tympanic Membrane Perforation Types

Doctors describe perforations by their location and cause. The main types include:

• Central perforation: The hole does not extend to the edge of the eardrum. This is the most common type.
• Marginal perforation: The hole extends to the edge of the eardrum. This can make it harder for the ear drum to heal on its own.
• Traumatic perforation: The hole is caused by injury, like a hit to the head or poking the ear with an object.
• Chronic perforation: The hole doesn’t heal after several weeks.

What Causes a Tympanic Membrane Perforation?

A ruptured eardrum can happen for many reasons. Common causes include:

• Ear infections: Can cause fluid to build up and pressure to break the eardrum
• Head trauma: A hit to the side of the head or a fall
• Foreign objects: Inserting items like cotton-tipped applicators (Q-Tips) into the ear
• Sudden pressure changes (barotrauma): For example, from flying in a plane or scuba diving

What Are the Symptoms of Tympanic Membrane Perforation?

A perforated eardrum can cause:

• Sudden sharp ear pain that goes away quickly
• Drainage from the ear (clear, bloody or pus)
• Hearing loss in the affected ear
• Ringing or buzzing in the ear (tinnitus)
• Dizziness or trouble with balance

Not all children feel pain. Sometimes the first sign is ear drainage or hearing changes. Call your primary care provider if your child has any of these symptoms.

How Is a Tympanic Membrane Perforation Diagnosed?

A healthcare provider will look inside the ear using a special lighted tool called an otoscope. They may see a hole or signs of infection. They may use these tests:

• Audiometry: This is a hearing test that checks how well your child hears different sounds. During the test, your child wears headphones and listens for tones at different pitches and volumes. They may also be asked to repeat words to see how clearly they hear speech.
• Tympanometry: This test measures how well the eardrum moves. A soft plug is placed in the ear, and the machine gently changes the air pressure. This helps the doctor see if there is fluid behind the eardrum or if it has a hole. The test is quick and is usually not painful.

How Is a Tympanic Membrane Perforation Treated?

Many perforations heal on their own in a few weeks to a few months. During healing:

• Keep the ear dry
• Avoid swimming
• Don’t blow the nose forcefully
• Avoid using Q-Tips or putting anything in the ear
• Use antibiotic drops if there is an infection

If the hole doesn’t close, your child may be referred to an ENT (ear, nose, throat) specialist. They may recommend:

• Patch procedure (myringoplasty): If the eardrum doesn’t heal on its own, a doctor may place a special paper-like patch over the hole or use a dissolvable foam to fill the hole. This helps the edges of the eardrum grow back together. The doctor may need to roughen the edges of the hole slightly before placing the patch to encourage healing. This procedure is usually done in the operating room and takes a few minutes.
• Surgery (tympanoplasty): If the perforation is large, long-lasting or is causing hearing problems, your child may need a bigger surgery. In a tympanoplasty, the surgeon takes a small piece of tissue, often from behind the ear or an artificial graft, and uses it to cover the hole in the eardrum. The procedure is done under general anesthesia, which means your child will be asleep and feel no pain. Most children go home the same day. Hearing may be worse initially after surgery due to the dissolvable packing that is placed in the ear. Full recovery takes several weeks. Hearing often gets better once the eardrum heals and any packing in the ear dissolves.

Prognosis for a Tympanic Membrane Perforation

Most children heal fully and regain normal hearing. The healing time depends on the size and cause of the perforation. Smaller holes may heal in a few weeks, while larger or chronic holes may take several months or need surgery. Children who are younger (less than 7 years old) are at higher risk for failed healing.

Preventing Tympanic Membrane Perforation

You can help prevent a ruptured eardrum by following these tips:

• Treat ear infections right away.
• Avoid using cotton-tipped applicators (Q-Tips) or anything that is inserted into the ear canal. You can clean your ears with a towel and your finger.
• When flying in an airplane, try chewing gum, swallowing, or opening your mouth to help open the eustachian tubes to relieve pressure.
• Use head and ear protection during sports like football, wrestling and baseball.