A ruptured (perforated) 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. Damage to your eardrum interrupts the hearing process and may impair your hearing.

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 an 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.

Signs and symptoms

A ruptured eardrum can be painful, particularly at first. Signs and symptoms may include:

• Sharp, sudden ear pain or discomfort

• Clear, pus-filled or bloody drainage from your ear

• Sudden decrease in ear pain followed by drainage

• Hearing loss

• Ringing in your ear (tinnitus)

Causes

Causes of a ruptured eardrum may include:

• Middle ear infection (otitis media). Middle ear infection may cause your eardrum to rupture as the pressure of the fluid in your middle ear increases. Conversely, a ruptured eardrum can cause infection because your eardrum is no longer intact, allowing bacteria to enter your middle ear.

• Airplane ear (barotrauma). Pressure on your ear, such as during ascent or descent of a flight, can cause your eardrum to rupture.

• Injury to your ear (acoustic trauma). Damage to your eardrum can occur from a direct injury, such as if your ear is struck squarely with an open hand.

• Foreign objects in your ear. Small objects such as a cotton swab or bobby pin pushed too far into your ear canal can rupture your eardrum. Attempts to clean earwax (cerumen) from your ear can damage your eardrum and cause infection of your outer ear canal (swimmer's ear).

• Loud, sudden noise. A sudden, extremely loud noise, such as from an 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.

Risk factors

Risk factors for tearing or rupturing your eardrum include:

• Fluid buildup from middle ear infection

• Cleaning your ear with small objects to clear away earwax buildup or blockage

• Excessive scratching of your ear due to itchy ears

Refrain from putting any foreign object inside your ear. Get treatment for middle ear infections promptly.

When to seek medical advice

Seek medical care if you have pain or swelling in your ear or drainage from your ear. Discharge of blood or pus may be a sign that your eardrum has ruptured. See your doctor immediately if you develop fever or headache, or if the pain in your ear becomes severe. Your doctor will examine the inside of your ear and may refer you to a doctor who specializes in the care of ear, nose and throat disorders.

• Headache
• Swimmer's ear

Screening and diagnosis

Your doctor will examine your ear to determine if you have a ruptured eardrum by using a lighted instrument (otoscope) to look inside your ear. A ruptured eardrum has a tear or a hole in it, and the bones of your middle ear may be visible behind your eardrum. If you have drainage from your ear, your doctor can take a sample of the fluid to be analyzed in the laboratory to determine if bacteria or fungi have caused infection.

 

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