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Ruptured Eardrum
- Overview, Causes, & Risk Factors
- Symptoms & Signs
- Diagnosis & Tests
- Prevention & Expectations
- Treatment & Monitoring
- Attribution
Overview, Causes, & Risk Factors
A perforated eardrum occurs when there is an opening in the membrane that separates the ear canal from the middle ear.
What is going on in the body?
The eardrum is the dividing line between the external and middle ear. The external ear is formed by the auricle, which is the external ear flap, and the external ear canal. The middle ear is the air-filled space behind the eardrum that contains the three small bones for hearing. The eardrum is an important barrier between the environment and the middle ear. It also vibrates to transmit sound, part of the normal hearing mechanism.
The eardrum may be ruptured due to trauma, such as a sharp blow to the external ear. It can also rupture when pressure builds up in the middle ear and pushes the eardrum outward.
What are the causes and risks of the condition?
Following are some of the common causes of a ruptured eardrum:
Sometimes, the eardrum is deliberately perforated when ear tubes are placed. A surgeon places these small tubes into the eardrum when a person has chronic ear infections. They allow drainage of infected material from the middle ear and lower the pressure within the middle ear.
Symptoms & Signs
What are the signs and symptoms of the condition?
Holes in the eardrum are usually caused by trauma or infection. If the rupture is the result of trauma, symptoms include the following:
If the rupture is the result of an infection, symptoms may include the following:
If the rupture is the result of tuberculosis, symptoms include a watery, clear ear drainage and hearing impairment.
If an individual has a middle ear infection, the ear pain lessens significantly when the eardrum ruptures. The degree of the hearing impairment depends on the size and location of the hole.
Diagnosis & Tests
How is the condition diagnosed?
The diagnosis of a ruptured eardrum starts with a medical history and physical examination. Most holes in the eardrum can be seen during an examination with an otoscope. An otoscope is a lighted microscope with an air pump that is specially designed for the ear.
The healthcare provider may direct a small amount of air into the ear with the otoscope. When there is a hole in the eardrum, the air will not make the eardrum move.
For very small holes, a tympanogram may be useful. A tympanogram measures eardrum movement and ear canal volume.
A hearing test can measure the degree of the hearing impairment. A hearing test can show if there has been damage to the nerve portion of hearing.
Prevention & Expectations
What can be done to prevent the condition?
The following recommendations can help prevent some cases of ruptured eardrum.
What are the long-term effects of the condition?
The main reason to repair an eardrum is to provide a safe ear. An unrepaired eardrum puts the middle and inner ear at risk for damage from pressure or infection. Holes in the eardrum can affect hearing.
What are the risks to others?
A ruptured eardrum is not contagious and poses no risk to others.
Treatment & Monitoring
What are the treatments for the condition?
When a hole in the eardrum is diagnosed, it is important to take the following steps.
Most ruptures caused by trauma, ear infections, and ear tubes will heal on their own. But some ruptures may require surgery. Patches of paper or fat are used to repair small holes. For larger holes, tissue is usually taken from the chewing muscle located in the temple. This tissue is then placed under the eardrum or on its surface. It acts as a scaffold for the drum to heal over.
What are the side effects of the treatments?
Surgery may cause bleeding, infection, or allergic reactions to anesthesia. Ear surgery may also cause hearing impairment.
What happens after treatment for the condition?
If treatment is successful, the protective barrier effect of the eardrum is restored. The person's hearing returns to a completely normal state.
How is the condition monitored?
Hearing should improve as the hole closes. If this does not happen, there may be another rupture. Anyone with a known rupture who gets water in the middle ear should use antibiotic eardrops to prevent an ear infection.
A person who has continued or recurrent episodes of ear drainage may have a chronic ear infection. The healthcare provider should be consulted. Any other new or worsening symptoms should also be reported to the provider.
Attribution
Author:Mark Loury, MD
Date Written:
Editor:Ballenberg, Sally, BS
Edit Date:04/30/01
Reviewer:Eileen McLaughlin, RN, BSN
Date Reviewed:08/09/01