A ruptured 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. A ruptured eardrum (also called a perforated eardrum) interrupts the hearing process and may impair your hearing.
Damage to the eardrum can occur from acoustic trauma such as direct injury or barotrauma (pressure-induced damage). Inserting cotton-tipped swabs or small objects into the ear to clean them sometimes causes a perforation of the eardrum. Foreign objects in the ear are another cause of perforated eardrum. Sudden extremely loud noise, such as 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.
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.
The ability of the eardrum to heal without complication or major scarring often led doctors in the “old days” to use a tiny knife to slit the eardrum (tympanocentesis) to relieve the pressure and pain. This cured the infection; sometimes they obtained a bacterial culture of the pus to identify the germ involved. This practice, which fell by the wayside to such a degree that very few pediatricians have ever done the procedure, may be coming back into use again because of the dramatic rise in antibiotic resistance of common middle ear disease bacteria.
A ruptured or perforated eardrum usually heals by itself within 2 months. However, antibiotics may be prescribed to prevent infection or to treat an existing infection. An eardrum patch may be applied to the eardrum to stimulate healing. Medication may also be prescribed to reduce the pain. 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.
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