1.

A ruptured eardrum, like a clap of thunder, can happen suddenly. You may feel a sharp pain in your
ear, or an earache that you've had for a while suddenly goes away. It's also possible that you may
not have any sign that your eardrum has ruptured.
A ruptured eardrum -- also known as a perforated eardrum or a tympanic membrane perforation -can lead to complications such as middle ear infections and hearing loss. It may also require surgery
to repair the damage to the eardrum. But typically, especially if you protect your ear, a ruptured
eardrum will heal on its own without treatment within a couple of months.

What Is a Ruptured Eardrum?

A ruptured eardrum is a tear in the thin membrane that separates your outer ear from your inner ear.
That membrane, known as the tympanic membrane, is made of tissue that resembles skin.

The eardrum serves two important functions in your ear. It senses vibrating sound
waves and converts the vibration into nerve impulses that convey the sound to
your brain. It also protects the middle ear from bacteria as well as water and foreign
objects. Normally, the middle ear is sterile. But when the eardrum is ruptured, bacteria
can get into the middle ear and cause an infection known as otitis media.

What Causes a Ruptured Eardrum?

A number of things can cause the eardrum to rupture; one of the most common causes
is an ear infection. When the middle ear is infected, pressure builds up and pushes
against the eardrum. When the pressure gets too great, it can cause the eardrum to
perforate. When that happens, you may suddenly notice that the pain and pressure
you've felt from the infection suddenly stops and pus drains from the ear.
Another common cause of a ruptured eardrum is poking the eardrum with a foreign
object, such as a cotton-tipped swab or a bobby pin that's being used to clean wax out
of the ear canal. Sometimes children can puncture their own eardrum by putting objects
such as a stick or a small toy in their ear.
Some ruptured eardrums result from what's known as barotrauma. This happens when
the pressure inside the ear and the pressure outside the ear are not equal. That can
happen, for example, when an airplane changes altitude, causing the air pressure in the
cabin to drop or rise. The change in pressure is also a common problem for scuba
divers.

A head injury or an ear slap can cause the eardrum to rupture. So can an acoustic
trauma caused by a sudden loud noise, such as an explosion or a sudden blast of loud
music.

What Are the Symptoms of a Ruptured Eardrum?

Some people don't notice any symptoms of a ruptured eardrum. Others see their doctor
only after several days of general discomfort in their ear and feeling that "something's
not quite right with the ear." Some people are surprised to hear air coming out their ear
when they blow their nose. Forcefully blowing your nose causes air to rise up to fill the
space in your middle ear. Normally this will cause the eardrum to balloon outward. But if
there is a hole in the eardrum, air will rush out. Sometimes the sound is loud enough for
other people to hear.
Other symptoms of a ruptured eardrum include:

Sudden sharp ear pain or a sudden decrease in ear pain

Drainage from the ear that may be bloody, clear, or resemble pus
Ear noise or buzzing
Hearing loss that may be partial or complete in the affected ear
Episodic ear infections
Facial weakness or dizziness

How Is a Ruptured Eardrum Diagnosed?

If you have any of the symptoms of a ruptured eardrum, the doctor will do an otoscopic
exam. An otoscope is an instrument with a light that's used to look inside the ear. In
most cases, if there is a hole or tear in the eardrum, the doctor will be able to see it.
Sometimes there may be too much wax or drainage for the doctor to clearly see the
eardrum. If this is the case, the doctor may clean the ear canal or prescribe eardrops for
you to use to help clear it. Sometimes, the doctor uses a rubber bulb attached to the
otoscope to blow a puff of air into the ear. If the eardrum is not ruptured, it will move
when the air hits it. If it is ruptured, it won't.
The doctor may also test your hearing to determine how much effect the ruptured
eardrum has had on your hearing; he or she may use a tuning fork to test it. The doctor
may also ask for an audiology test, which uses a series of tones you listen to with

headphones to determine your level of hearing. Most hearing loss due to a ruptured
eardrum is temporary. Normal hearing returns usually after the eardrum heals.

How Is a Ruptured Eardrum Treated?

Typically, no specific treatment is needed for a ruptured eardrum; the vast majority of
ruptured eardrums heal within three months. Your doctor may prescribe an antibiotic -either oral or in the form of eardrops -- to prevent an ear infection or treat an existing
infection. If the ruptured eardrum is causing you pain, the doctor may recommend using
an over-the-counter pain medication such as acetaminophen or ibuprofen. Warmth may
be applied also to relieve discomfort.
If the eardrum is slow to heal, the doctor may put a patch over the eardrum. In some
cases, surgery may be needed to repair a ruptured eardrum. The surgery is usually
done on an outpatient basis. During the procedure, which usually takes a couple of
hours, the doctor will attach a piece of your own tissue to the eardrum to rebuild the
eardrum. Surgery is most commonly used for large perforations, for perforations that
involve the edges of the eardrum, or for ruptured eardrums caused by an ear infection.
While the eardrum heals, you'll need to keep the ear dry. That means no swimming or
diving until the doctor says the eardrum is healed. You'll also need to use a shower cap
or place cotton coated with petroleum jelly in your outer ear when you shower to keep
water out. Other precautions include:

Not using medicine other than what's prescribed by your doctor in your ear
Taking all the medicine prescribed by the doctor
Protecting the ear from cold air
Avoiding blowing your nose while the ear heals

How Can a Ruptured Eardrum Be Prevented

The two most important steps you can take to prevent a ruptured eardrum are to avoid
putting any object into your ear -- even to clean it -- and to treat ear infections promptly.
It's also important to see a doctor to remove a foreign object in your ear rather than try
to remove it yourself.

2. What Is an Eardrum
Rupture?
An eardrum rupture is a small hole or tears in your eardrum,
or tympanic membrane. The tympanic membrane is a thin
tissue that divides your middle ear and outer ear canal.
This membrane vibrates when sound waves enter your ear.
The vibration continues through the bones of the middle ear.
You hear sounds because of this vibration, so your hearing
can suffer if your eardrum is damaged.
A ruptured eardrum is also called a perforated eardrum. In
rare cases, the condition can cause permanent hearing loss.

Causes of Eardrum
Rupture
Infection
Ear infections are a common cause of eardrum rupture,
especially in children. When you have an ear infection, fluids
accumulate behind the eardrum. The pressure caused by the

buildup of fluids can cause the tympanic membrane to break

or rupture.

Pressure Changes
Other activities that cause a change of pressure in the ear
can also lead to a perforated eardrum. These include:

scuba diving
flying in an airplane
driving at high altitudes

Injury or Trauma
An injury can also rupture your eardrum. Any type of trauma
to the ear or side of the head can cause a rupture. Even
cleaning your ears with cotton swabs can be potentially
damaging to your eardrum if you are not careful.
Acoustic traumaor damage to the ear due to extremely loud
noisescan cause your eardrum to rupture. However, these
cases are not as common.

Part 3 of 5: Symptoms

Symptoms of Eardrum
Rupture
Pain is the main symptom of eardrum rupture. Every person
experiences the pain differently. For some, the pain may be
severe. It can remain steady throughout the day, or it can
increase or decrease in intensity.
Usually the ear begins to drain once the pain goes away. The
eardrum at this point is ruptured, and fluids that are watery,
bloody, or filled with pus may drain from the affected ear.
You may have some temporary hearing loss, or a reduction in
hearing in the affected ear. You can also experience tinnitus
a ringing or buzzing in the ears.
If your eardrum was severely ruptured, you might suffer from
additional symptoms, such as dizziness or a weakness in your
facial muscles.

Part 4 of 5: Treatment

Treatment for Eardrum

Rupture
Treatments for an eardrum rupture are mainly designed to
relieve pain and to eliminate or prevent infection. You can
ease the pain of a ruptured eardrum at home with heat and
pain relievers. One simple remedy is to place a warm, dry
compress on your ear several times daily.

Patching
If your ear does not heal on its own, your doctor might decide
to patch the eardrum. Patching involves placing a medicated
paper patch over the tear in the membrane. The patch
encourages the membrane to grow back together.

Antibiotics
Antibiotics will clear up the infection that might have led to
your eardrum rupture. They will also protect you from
developing new infections as a result of the perforation. Your
doctor may prescribe antibiotics in an oral pill form or as
medicated eardrops. You may also be told to use both forms
of medication.

Surgery
In rare cases, surgery may be required to patch the hole in
the eardrum. A surgical repair of a perforated eardrum is

called tympanoplasty. During tympanoplasty, your surgeon

takes tissue from another area of your body and grafts it onto
the hole in your eardrum.

Outlook, Recovery,
and Prevention of
Future Ruptures
A ruptured eardrum often heals without any invasive
treatment. Most people with ruptured eardrums experience
only a temporary hearing loss. You can usually expect a full
recovery within eight weeks.
You can promote healing by not blowing your nose any more
than absolutely necessary. Blowing your nose creates
pressure in your ears. The increased pressure can be painful
and can also slow your eardrums healing. It is important to
keep your ear dry to prevent further infection. You can gently
stuff your ears with cotton when you bathe to prevent water
from entering the ear canal. Your doctor will most likely ask
you to avoid swimming until your ear heals.

3.
A hole or rupture in the eardrum, a thin membrane that separates the ear
canal and the middle ear, is called a perforated eardrum. The medical term
for eardrum is tympanic membrane. The middle ear is connected to the nose
by the Eustachian tube, which equalizes pressure in the middle ear. A
perforated eardrum is often accompanied by decreased hearing and
sometimes liquid discharge. The perforation may be accompanied by pain, if
it is caused by an injury or becomes infected.

WHAT CAUSES EARDRUM PERFORATION?

The causes of an eardrum hole are usually from injury, infection, or chronic
Eustachian tube disorders. A perforated eardrum from trauma can occur:

If the ear is struck directly

With a skull fracture

After a sudden explosion

If an object (such as a bobby pin, Q-tip, or stick) is pushed too far into the
ear canal

Middle ear infections may cause pain, hearing loss, and spontaneous rupture
of the eardrum, resulting in a perforation. In this case,there may be infected
or bloody drainage from the ear. Infections can cause a hole in the eardrum
as a side effect of otitis media. Symptoms of acuteotitis media (middle ear
fluid with signs of infection) include a senese of fullness in the ear, some
hearing loss, pain, and fever.
In patients with chronic Eustachian tube problems the ear drum may become
weakened and open up.
On some occasions a small hole may remain in the eardrum after a

previously placed pressure-equalizing (PE) tube falls out or is removed by a

physician.
Most eardrum holes resulting from injury or an acute ear infection heal on
their own within weeks of opening,although some may take several months
to heal. During the healing process the ear must be protected from water
and trauma. Eardrum perforations that do not heal on their own may require
surgery. How is hearing affected by a perforated eardrum?

HOW IS HEARING AFFECTED BY A PERFORATED EARDRUM?

Usually the size of the perforation determines the level of hearing loss--a
larger hole will cause greater hearing loss than a smaller hole. If
severe injury (e.g., skull fracture) moves the bones in the middle ear that
send out sound, out of place, or injuries the inner ear, hearing loss may be
serious.
If the perforated eardrum is caused by a sudden traumatic or violent event,
the loss of hearing can be great and tinnitus (ringing in the ear) may occur.
Chronic infection as a result of the perforation can cause longer lasting or
worsening hearing loss.

HOW IS A PERFORATED EARDRUM TREATED?

Before attempting any correction of the perforation, a hearing test should be
performed. The benefits of closing a perforation include prevention of water
entering the middle ear while showering, bathing, or swimming (which could
cause ear infection), improved hearing, and lessened tinnitus. It also may
prevent the development of cholesteatoma (skin cyst in the middle ear),
which can cause chronic infection and destruction of ear structures.
If the perforation is very small, an otolaryngologist (your ear, nose
and throat physician) may choose to observe the perforation over time to
see if it will close on its own. He or she might try to patch a patients eardrum
in the office. Working with a microscope, your doctor may touch the edges of the eardrum with a
chemical to stimulate growth and then place a thin paper patch on the eardrum.
Usually with closure of the ear drum, hearing is improved. Several patches
may be required before the perforation closes completely. If your physician
feels that a paper patch will not provide prompt or adequate closure of the

hole in the eardrum, or if paper patching does not help, surgery may be
required.
There are a variety of options for treatment, but most involve placing a patch
across the perforation to allow healing. The name of the procedure is
tympanoplasty. Surgery is typically quite successful in repairing the
perforation, bringing back or improving hearing, and is often done in the
physician's office.
Your doctor will advise you regarding the proper care of a hole in the
eardrum.

4. Perforated Eardrum
A torn (perforated) eardrum is not usually serious and often heals on its
own without any complications. Complications sometimes occur such as
hearing loss and infection in the middle ear. A small procedure to repair a
perforated eardrum is an option if it does not heal by itself, especially if
you have hearing loss.

What is the eardrum and how do we hear?

The eardrum (also called the tympanic membrane) is a thin skin-like structure in the ear. It lies
between the outer and middle ear.
The ear is divided into three parts - the outer, middle and inner ear. Sound waves come into the
outer (external) ear and hit the eardrum, causing the eardrum to vibrate.
Behind the eardrum are three tiny bones (ossicles). The vibrations pass from the eardrum to these
middle ear bones. The bones then transmit the vibrations to the cochlea in the inner ear. The
cochlea converts the vibrations to sound signals which are sent down a nerve to the brain, which we
'hear'.
The middle ear behind the eardrum is normally filled with air. The middle ear is connected to the
back of the nose by the Eustachian tube. This allows air in and out of the middle ear.

What is a perforated eardrum and what problems

can it cause?
A perforated eardrum is a hole or tear that has developed in the eardrum. It can affect hearing.
However, the extent of hearing loss can vary greatly. For example, tiny perforations may only cause
minimal loss of hearing. Larger perforations may affect hearing more severely. Also, if the tiny bones
(ossicles) are damaged in addition to the eardrum then the hearing loss would be much greater than,
say, a small perforation which is not close to the ossicles.

Also, with a perforation, you are at greater risk of developing an ear infection. This is because the
eardrum acts as a barrier to bacteria and other germs that may get into the middle ear.

What can cause a perforated eardrum?

Causes include:

Infections of the middle ear, which can damage the eardrum. In this situation you often have
a discharge from the ear as pus runs out from the middle ear.

Direct injury to the ear - for example, a punch to the ear.

A sudden loud noise - for example, from a nearby explosion. The shock waves and sudden
sound waves can tear (perforate) the eardrum. This is often the most severe type of perforation
and can lead to severe hearing loss and ringing in the ears (tinnitus).

Barotrauma. This occurs when you suddenly have a change in air pressure and there is a
sharp difference in the pressure of air outside the ear and in the middle ear. For example, when
descending in an aircraft. Pain in the ear due to a tense eardrum is common during height
(altitude) changes when flying. However, a perforated eardrum only happens rarely in extreme
cases. See separate leaflet called Barotrauma of the Ear.

Poking objects into the ear. This can sometimes damage the eardrum.

Grommets. These are tiny tubes that are placed through the eardrum. They are used to treat
glue ear, as they allow any mucus that is trapped in the middle ear to drain out from the ear.
When a grommet falls out, there is a tiny perforation in the eardrum (that usually soon heals).

How is a perforated eardrum diagnosed?

A doctor can usually diagnose a torn (perforated) eardrum simply by looking into the ear with a
special torch called an otoscope. However, sometimes it is difficult to see the eardrum if there is a lot
of inflammation, wax or infection present in the ear.

What is the treatment for a perforated

eardrum?
No treatment is needed in most cases
A torn (perforated) eardrum will usually heal by itself within 6-8 weeks. It is a skin-like structure and,
like skin that is cut, it will usually heal. In some cases, a doctor may prescribe antibiotic medicines if
there is an infection or risk of infection developing in the middle ear whilst the eardrum is healing.
It is best to avoid water getting into the ear whilst it is healing. For example, your doctor may advise
that you put some cotton wool or similar material into your outer ear whilst showering or washing
your hair. It is best not to swim until the eardrum has healed.

Medical treatment
Occasionally, a perforated eardrum gets infected and needs antibiotics. Some ear drops can
potentially damage the nerve supply to the ear so your doctor will select a type that does not have
this risk, or will give you medication by mouth.

Surgical treatment is sometimes considered

A small procedure is an option to treat a perforated drum that does not heal by itself. There are
various techniques ranging from placing some chemicals next to the torn part of the drum to
encourage healing, to an operation called tympanoplasty to repair the eardrum. Tympanoplasty is
usually successful in fixing the perforation,and improving hearing.
However, not all people with an unhealed perforation need treatment. Many people have a small
permanent perforation with no symptoms or significant hearing loss. Treatment is mainly considered
if there is hearing loss, as this may improve if the perforation is fixed. Also, swimmers may prefer to
have a perforation repaired, as getting water in the middle ear can increase the risk of having an ear
infection.
If you have a perforation that has not healed by itself, a doctor who is an ear specialist will advise on
the pros and cons of treatment versus leaving it alone.