Conditions

Eardrum Perforation

Also known as: Perforated eardrum · Tympanic membrane perforation · Ruptured eardrum

A perforated eardrum is a hole in the tympanic membrane, the thin tissue separating the ear canal from the middle ear. Many perforations heal on their own; those that do not can usually be repaired surgically with a high rate of success.

What it is

The tympanic membrane, or eardrum, is a thin three-layered membrane that separates the ear canal from the middle ear. It vibrates in response to sound and transmits that motion to the middle ear bones. It also seals the middle ear off from the outside environment.

A perforation is a hole in that membrane. It interferes with hearing in two ways: it reduces the surface area available to collect sound, and it removes the pressure difference across the eardrum that normal sound transmission depends on. It also leaves the middle ear exposed to water and bacteria from the ear canal.

Causes

  • Infection. Acute otitis media can build enough pressure behind the eardrum to rupture it. This often relieves the pain abruptly and is followed by drainage.
  • Trauma. A direct blow to the ear, a slap, an object inserted into the ear canal, or a cotton swab pushed too far.
  • Barotrauma. Rapid pressure changes from flying, diving, or a blast.
  • Ventilation tubes. A small number of ears retain a perforation after a tube falls out.
  • Chronic ear disease. Long-standing middle ear disease, including cholesteatoma, can leave a persistent perforation.

Symptoms

  • Hearing loss on the affected side, typically conductive and proportional to the size and position of the hole
  • Drainage from the ear, especially after water exposure or during an infection
  • Recurrent ear infections
  • Tinnitus or a sensation of fullness
  • Sudden pain that resolves abruptly, in the case of a perforation caused by an acute infection

Some perforations produce no symptoms at all and are discovered incidentally.

Diagnosis

The diagnosis is made by examining the eardrum, usually under magnification with an otoscope, microscope, or endoscope, which shows the size, location, and edges of the perforation and the condition of the middle ear behind it. An audiogram documents the degree and type of hearing loss and establishes whether the middle ear bones are also involved. Tympanometry may be used to confirm the perforation objectively.

If there is drainage, chronic disease, or suspicion of cholesteatoma, a CT of the temporal bone may be obtained.

Treatment

Observation. Small, recent perforations are frequently given time to heal on their own, with water precautions and treatment of any active infection.

Tympanoplasty. Surgical repair uses a graft to close the hole. Grafting material is taken from the patient’s own tissue — most commonly temporalis fascia, or cartilage and perichondrium harvested from the ear itself. Cartilage is often preferred for larger perforations, revision cases, and ears with ongoing Eustachian tube dysfunction, because it resists retraction over time.

The approach may be through the ear canal, endoscopic, or through an incision behind or in front of the ear, depending on the anatomy and the extent of the work required. Success rates for closure are high in appropriately selected ears.

Ossiculoplasty. If the middle ear bones have been eroded or fixed, they can be reconstructed at the same time or at a subsequent operation, depending on the condition of the ear.

Paper patch or office procedures. Some small perforations can be treated in the office with a patch that supports healing, avoiding a trip to the operating room in selected cases.

Recovery

Recovery specifics depend on the approach used, but generally involve keeping the ear dry for a period of weeks, avoiding nose blowing and heavy straining while the graft heals, and follow-up visits to clean the ear and confirm the graft has taken. Hearing is usually reassessed with a repeat audiogram once healing is complete, since packing in the ear canal makes earlier testing unreliable.

Common questions

Will a perforated eardrum heal on its own?

Often, yes. Many perforations — particularly small ones caused by an infection or a sudden pressure change — close spontaneously within a few weeks to a few months. Perforations that remain open beyond about three months are unlikely to close without intervention.

Can I swim or shower with a perforated eardrum?

Water entering the middle ear through a perforation can cause infection and drainage, so keeping the ear dry is usually advised while the perforation is open. Your surgeon can recommend specific precautions and custom earplugs.

How much hearing will I get back after repair?

If the hearing loss is caused by the perforation alone, closing it typically improves hearing. If the middle ear bones have also been damaged or eroded, hearing may remain reduced until those are addressed as well, which can be done during the same operation or a later one.

Is the surgery done through an incision behind the ear?

Not always. Smaller perforations can often be repaired entirely through the ear canal, sometimes endoscopically, with no external incision. Larger or more complex perforations may require an incision behind or in front of the ear. The approach is chosen based on the size and location of the perforation and the condition of the middle ear.

Where can I have a perforated eardrum repaired in Colorado?

Dr. Ashley Nassiri evaluates and repairs eardrum perforations at UCHealth University of Colorado Hospital, on the University of Colorado Anschutz Medical Campus in Aurora, Colorado, in the Denver metropolitan area. She is a fellowship-trained neurotologist and skull base surgeon, and appointments are arranged through UCHealth.

Related

Cholesteatoma Hearing Loss Osseointegrated Hearing Devices

Where this care is provided

Dr. Ashley Nassiri is a fellowship-trained neurotologist and skull base surgeon at UCHealth University of Colorado Hospital, on the University of Colorado Anschutz Medical Campus in Aurora, Colorado, in the Denver metropolitan area. Patients seeking evaluation for an eardrum perforation can schedule by calling the clinic below or through UCHealth. There is also an overview of what a neurotologist treats and when to ask for a referral.

Call 720-848-2820 UCHealth provider page

UCHealth Ear, Nose and Throat Clinic – Anschutz Outpatient Pavilion, Aurora, Colorado

This page provides general information about a medical condition or procedure and is not medical advice. It is not a substitute for evaluation by a qualified clinician, and it cannot account for the specifics of any individual case. If you have symptoms that concern you, seek care directly.