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; they 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, you may be referred to an ear nose and throat doctor who may place 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 use water-repellent earplugs (like swimmer's wear) 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.