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If You Have a Hole in your Eardrum

Frederic E. Levy, MD

A perforated eardrum is a hole or rupture in the eardrum, or tympanic membrane, which separates the ear canal and the middle ear. 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 occasional discharge. Pain is usually not persistent.

The causes of perforated eardrum are usually from trauma or infection. Traumatic perforations can occur from a blow to the ear, a skull fracture, or a sudden explosion. If an object such as a bobby pin, Q-tip, or stick is pushed too far into the ear canal, it can create a painful rupture of the eardrum. Never place a Q-tip down into the ear canal. On rare occasions a small hole may remain in the eardrum after a previously placed PE tube (pressure equalizing) either falls out or is removed by the physician. Also if hot slag (from welding) or acid enters the ear canal, it can burn a hole through the tympanic membrane.

Middle ear infections may cause pain, hearing loss and spontaneous rupture (tear) of the eardrum resulting in a perforation. In this circumstance, there may be infection or bloody drainage from the ear. In medical terms, this is called Otitis media with perforation.

Most eardrum perforations heal spontaneously within weeks after rupture, although some may take up to several months. During the healing process the ear must be protected from water and trauma. Those eardrum perforations which do not heal on their own may require surgery. The benefits of closing a perforation include prevention of water entering the ear while showering, bathing or swimming (which could cause ear infection), improved hearing, and diminished tinnitus (ringing in the ear). If the perforation is very small, otolaryngologists may choose to observe the perforation over time to see if it will close spontaneously or 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 tympanic membrane, improvement in hearing is noted. If your physician feels that a paper patch will not provide prompt or adequate closure of the hole in the eardrum, or attempts with paper patching do not promote healing, surgery is considered.

Usually, the larger the perforation, the greater the loss of hearing. The location of the hole (perforation) in the eardrum also affects the degree of hearing loss. If severe trauma (e.g. skull fracture) disrupts the bones in the middle ear, which transmit sound, or causes injury to the inner ear structures, the loss of hearing may be quite severe. If the perforated eardrum is due to a sudden traumatic or explosive event, the loss of hearing can be great and ringing in the ear (tinnitus) may be severe. In this case the hearing usually returns partially, and the ringing diminishes in a few days. Before attempting any correction of the perforation, a hearing test should be performed.

There are a variety of surgical techniques, but all basically place tissue across the perforation allowing healing. The name of this procedure is called tympanoplasty. Surgery is typically quite successful in closing the perforation permanently, and improving hearing. It is usually done on an outpatient basis.