Perforated Eardrum In Adults

Introduction

The technical name for your eardrum is the tympanic membrane. It’s a thin, circular layer of tissue located at the end of your ear canal that separates the outer ear from the middle ear. The eardrum plays an essential role in your ability to hear sounds. The eardrum also protects the middle ear from dirt and debris. 

A perforated eardrum (sometimes referred to as a burst or ruptured eardrum) is a tear or hole in the tympanic membrane. This usually affects just one ear and can occur after an injury, infection, loud noise, or a change in air pressure (for example when flying in an airplane). The eardrum will usually heal by itself within a couple of months but some people will need interventions, such as antibiotics or surgery, to help them recover.

It is important to recognise the symptoms of a perforated eardrum because the tear in the membrane can leave your ear more vulnerable to infections. A perforated eardrum can also affect your balance and result in hearing loss.¹

Symptoms of a perforated eardrum in adults

According to the NHS, symptoms usually just affect one ear and begin suddenly after you experience an infection, physical trauma to the ear, a loud noise or a sudden change in air pressure. 

Pain in the ear

A perforated eardrum may present  with sudden pain or a dull ache in your ear. You’re more likely to experience sharp pain if the rupture is caused by physical injury, such as something sharp entering the ear, while an infection is more likely to cause a dull, achy feeling in your ear.

Hearing loss

One of the most common complaints for patients with a perforated eardrum is hearing loss. This is usually just in the affected ear and often resolves as the membrane heals. Muffled sounds and decreased sensitivity to sounds at different volumes and pitches can also be signs of a perforated eardrum. 

Ear discharge

A discharge may leak from the affected ear. The fluid coming out of the ear can be clear, pus-like or bloody. The discharge may be accompanied by an unpleasant odour. 

Ringing in the ear (tinnitus)

Tinnitus presents as a buzzing or ringing noise in the ear. 

Vertigo or dizziness

Vertigo or dizziness can occur because of the pressure change within the ear. This might be accompanied by nausea and vomiting. These symptoms often disappear when the ear has healed but are sometimes persistent. 

Causes of a perforated eardrum in adults

Trauma to the ear

• Injury from a sharp object or blast injury

Blast-induced perforation of the tympanic membrane occurs often during combat operations. Damage to hearing is the most common organ injury after an explosion because the ears are so sensitive to changes in pressure.²

If a sharp object enters the ear, such as pieces of metal from an explosion, the tympanic membrane can rupture from the force of the impact. 

• Physical injury from inserting objects into the ear

Objects purposely inserted into the ear canal, such as cotton swabs that many people use to clean their ears with, can perforate the eardrum. Objects accidentally inserted into the ear, such as button batteries and small toys, can also cause damage.³

Infection

• Ear infections

Ear infections, particularly of the middle ear, are the most common causes of a perforated eardrum. The middle ear is located behind the eardrum and is usually kept clean and dry because it is well-ventilated when air passes through the eustachian tube. If eustachian tube dysfunction occurs, meaning that the tube is clogged or blocked (glue ear), the middle ear becomes susceptible to bacteria. There are different reasons why the eustachian tube might become blocked, including allergies, viral infections and sinus infections. When the middle ear becomes infected, the combination of built-up fluid and inflammation in the middle ear exerts pressure on the nearby eardrum, potentially causing it to burst. ⁴

• Sinus infections

Sinusitis can lead to pressure building up in the eustachian tube which, as with middle ear infections, causes pressure to also rise in the middle ear, pushing it against the eardrum and potentially causing perforation. 

Changes in pressure

Barotrauma is used to describe medical conditions occurring when your body cannot adjust quickly enough to sudden changes in air or water pressure.

Ear injury barotrauma occurs when the pressure outside the ear and the pressure in the middle ear are unequal, such as when you are flying in an airplane or diving in the sea. Patients report a feeling that their ears are ‘full’, hearing loss and severe ear pain. Often this is short-lived but occasionally, barotrauma can lead to a burst eardrum. 

Loud noise exposure

Acoustic trauma is different from noise-induced hearing loss. Experiencing an overwhelming sound wave caused by an event, such as an explosion or gunshot, can damage the tympanic membrane. The noise itself is characterised as a single pulse sound or short burst of sound with a duration between 0.001 and 1 second.⁵

Diagnosis and treatment of a perforated eardrum in adults

Diagnosis

• Physical examination of the ear

An otoscope is an instrument used to examine the inside of the ear. Your medical professional will likely look for swelling of the eardrum and signs of infection, such as redness. The tear in the eardrum might be visible through the otoscope.⁶

• Hearing tests

If you are experiencing hearing loss, an audiologist might carry out some tests. These tests may include analysing your ability to hear sound at different volumes and pitches. They might also test the motility of your eardrum by completing tympanometry. Tympanometry involves inserting a small probe into the ear that delivers air and a low-toned noise to the tympanic membrane. There’s a microphone attached to the probe that will record how the tympanic membrane responds to the air and sound.

• Imaging tests (such as CT scan or MRI)

It’s not often necessary to carry out imaging tests to diagnose a perforated eardrum but if it's not clear what is causing your symptoms, doctors might recommend that you have a scan. 

Treatment

Most perforated eardrums heal on their own. Pain relief medication can be taken to reduce discomfort and antibiotics can be prescribed by a doctor if there is an infection, or to prevent one from developing whilst your eardrum heals. Sometimes surgery is needed. While your ear is healing, you should keep it dry by avoiding swimming and preventing water from entering the ear whilst showering. 

• Eardrum patching or surgical repair

In some cases, a surgery called myringoplasty is necessary to repair a perforated eardrum. Myringoplasty involves the patient being under general or local anaesthesia. There is either a cut made behind the ear to gain access to the tympanic membrane or sometimes it is completed through the ear canal with the assistance of an endoscope. A graft is made from cartilage located in front of the ear canal or sometimes synthetic grafts are used. The graft is then used as a patch to cover the hole in the eardrum. 

Prevention of a perforated eardrum in adults

The best way to cope with a perforated eardrum is by preventing it in the first place. You can follow these steps to protect yourself from ear damage:

• Avoid loud noise exposure by wearing ear defenders and protective equipment 
• Do not insert objects into your ear, such as cotton buds, and practice safe ear-cleaning methods (ear drops)
• Treat ear infections promptly to avoid complications
• Use earplugs or protective gear in high-pressure environments
• Chew gum, yawn and blow your nose whilst flying to protect your ears 

Summary

In summary, a perforated eardrum is a hole in the tympanic membrane of the ear. It can cause several unpleasant symptoms, such as hearing loss and ear pain. The causes of perforation can vary, ranging from infection and injury to responses to sudden changes in air pressure. It can be diagnosed by a GP. The course of treatment usually involves painkillers and antibiotics to prevent infection. Surgery can be carried out, especially for larger tears in the membrane. Sometimes patients are left with long-term consequences, such as persistent vertigo and hearing loss, but the vast majority recover completely within a couple of months. Following advice on how to protect your ears, which includes wearing hearing protection in loud environments and correctly cleaning your ears, can reduce the risk of a perforated eardrum.