January 20, 2007

Ruptured Eardrum


A ruptured (perforated) eardrum is a tear or a hole in your eardrum (tympanic membrane), the thin membrane that separates your ear canal from your middle ear. This membrane vibrates when sound waves strike it, starting the process of converting sound waves into nerve impulses that travel to your brain. Damage to your eardrum interrupts the hearing process and may impair your hearing.

The eardrum also acts as a barrier to keep outside material, such as bacteria, from entering your middle ear. When your eardrum is ruptured, bacteria can more easily reach your middle ear and cause infection.

A variety of factors can cause a ruptured eardrum. These include a prior infection, injury and noise. Most ruptured eardrums heal within a few weeks without treatment. If the tear or hole in your eardrum doesn't heal by itself, you may need treatment.

Signs and symptoms
A ruptured eardrum can be painful, particularly at first. Signs and symptoms may include:

Sharp, sudden ear pain or discomfort
Clear, pus-filled or bloody drainage from your ear
Sudden decrease in ear pain followed by drainage from that ear
Hearing loss
Ringing in your ear (tinnitus)

Causes of a ruptured eardrum may include:

Middle ear infection (otitis media). A middle ear infection may cause your eardrum to rupture as the pressure of the fluid in your middle ear increases. Conversely, a ruptured eardrum can lead to an infection because your eardrum is no longer intact, allowing bacteria to enter your middle ear.

Airplane ear (barotrauma). Pressure on your ear, such as during ascent or descent of a flight, can cause your eardrum to rupture.

Injury to your ear (acoustic trauma). Damage to your eardrum can occur from a direct injury, such as if your ear is struck squarely with an open hand.

Foreign objects in your ear. Small objects such as a cotton swab or bobby pin pushed too far into your ear canal can rupture your eardrum. Attempts to clean earwax (cerumen) from your ear can damage your eardrum and cause infection of your outer ear canal (swimmer's ear).

Loud, sudden noise. A sudden, extremely loud noise, such as from an explosion or a firearm, can rupture your eardrum. Your loss of hearing may be great, and ringing in your ear (tinnitus) may be severe. Hearing usually returns partially, and the ringing in your ear often diminishes in a few days. But in some cases it may last indefinitely.

Risk factors
Risk factors for tearing or rupturing your eardrum include:

Fluid buildup from middle ear infection
Cleaning your ear with small objects to clear away earwax buildup or blockage
Excessive scratching of your ear due to itchy ears

Refrain from putting any foreign object inside your ear. Get treatment for middle ear infections promptly.

When to seek medical advice
Seek medical care if you have pain or swelling in your ear or drainage from your ear. Discharge of blood or pus may be a sign that your eardrum has ruptured. See your doctor immediately if you develop fever or headache, or if the pain in your ear becomes severe.

Screening and diagnosis
Your doctor will examine your ear to determine if you have a ruptured eardrum by using a lighted instrument (otoscope) to look inside your ear. He or she may refer you to a doctor who specializes in the care of ear, nose and throat disorders (otolaryngologist).

A ruptured eardrum has a tear or a hole in it, and the bones of your middle ear may be visible behind your eardrum. If you have drainage from your ear, your doctor can take a sample of the fluid to be analyzed in the laboratory to determine if bacteria or fungi have caused infection.

A ruptured eardrum usually isn't serious and often heals on its own without complications. But problems may occur, including:

Hearing loss. Usually, hearing loss is temporary, lasting only until the tear or hole in your eardrum has healed. The larger the tear or hole in your eardrum, the greater your hearing loss tends to be. The location of the tear or hole also may affect the degree of hearing loss. If severe trauma, such as a skull fracture, damages the bones in your middle ear and causes injury to the structure of your inner ear, loss of hearing may be severe and permanent.

Recurrent middle ear infection (chronic otitis media). Persistent or recurrent inflammation or infection of your middle ear caused by a large tear or hole in your eardrum can cause permanent damage and hearing loss.

Most ruptured eardrums heal without treatment within a few weeks, although some may take months. If the tear or hole in your eardrum doesn't heal by itself, treatment involves steps to close the perforation. Treatments may include:

Eardrum patch. If the tear or hole in your eardrum is small, an otolaryngologist may seal it with a paper patch. This procedure is done in the doctor's office. Your doctor may touch the edges of your eardrum with a chemical to stimulate growth and then place a thin paper patch on your eardrum. Your ear may need several applications of a patch (up to three or four) before the perforation closes completely.

Surgery. If your doctor determines that a paper patch won't provide prompt and adequate closure of the tear or hole in your eardrum, or if attempts with paper patching fail to heal the damage, you may need surgery. During a procedure called tympanoplasty, your surgeon places a tissue patch across the perforation, allowing it to heal. Tympanoplasty is often successful in closing the tear or hole permanently and restoring hearing. This procedure is done on an outpatient basis, meaning you can go home the same day.

Closing a perforation in your eardrum can:

Prevent water from entering your ear while showering, bathing or swimming, each of which could lead to a middle ear infection
Improve your hearing
Diminish ringing in your ears (tinnitus)

Prevent the development of a skin cyst in your middle ear (cholesteatoma), a cyst that can cause chronic middle ear infections and damage the structure of your ear

Follow these tips to avoid a ruptured eardrum:

Get treatment for middle ear infections. Be aware of the signs and symptoms of middle ear infection and seek treatment accordingly. Control the infection before it worsens enough to rupture your eardrum.

Protect your ears during flight. Prevent your ears from popping and your eardrums from rupturing while flying. Don't fly if you have a cold or an active allergy that causes you to be congested. Wear pressure-equalizing earplugs or chew gum during ascent and descent to keep your ears clear.

Keep your ears free of foreign objects. Never attempt to dig out excess or hardened earwax with items such as a cotton swab, paper clip or hairpin. These items can easily tear or puncture your eardrum. Teach children about the damage that can be done by putting foreign objects in their ears.

Guard against excessive noise. Protect your ears from unnecessary damage by wearing protective earplugs or earmuffs in your workplace or during recreational activities if loud continuous noise is present. Keep the volume down when listening to music or television.

Try these steps to stay comfortable while your eardrum heals:

Use warmth. Place a warm (not hot) heating pad over or against your ear to help reduce pain.

Keep your ear dry while it's healing. Use earplugs when showering or bathing.

Refrain from cleaning your ears. Give your eardrum time to heal completely.

Use pain relievers. Try aspirin or ibuprofen (Advil, Motrin, others) to help ease your ear pain. Ask your doctor which over-the-counter pain medication is best for you.

Adapted from: Mayo Foundation for Medical Education and Research