Ruptured eardrum (perforated eardrum)
A ruptured eardrum (tympanic membrane perforation) is a hole or tear in the thin tissue that separates your ear canal from your middle ear (eardrum).
A ruptured eardrum can result in hearing loss. It can also make your middle ear vulnerable to infections.
A ruptured eardrum usually heals within a few weeks without treatment. But sometimes it requires a patch or surgical repair to heal.
Signs and symptoms of a ruptured eardrum may include:
- Ear pain that may subside quickly
- Mucuslike, pus-filled or bloody drainage from your ear
- Hearing loss
- Ringing in your ear (tinnitus)
- Spinning sensation (vertigo)
- Nausea or vomiting that can result from vertigo
When to see a doctor
Call your doctor if you experience signs or symptoms of a ruptured eardrum. Your middle and inner ears are made up of delicate structures that are sensitive to injury or disease. It is important to try to figure out the cause of your ear symptoms and determine whether a ruptured eardrum has occurred.
Causes of a ruptured (perforated) eardrum may include:
- Middle ear infection (otitis media). A middle ear infection often results in the accumulation of fluids in your middle ear. Pressure from these fluids can cause the eardrum to rupture.
Barotrauma. Barotrauma is stress exerted on your eardrum when the air pressure in your middle ear and the air pressure in the environment are out of balance. If the pressure is severe, your eardrum can rupture. Barotrauma is most often caused by air pressure changes associated with air travel.
Other events that can cause sudden changes in pressure — and possibly a ruptured eardrum — include scuba diving and a direct blow to the ear, such as the impact of an automobile air bag.
- Loud sounds or blasts (acoustic trauma). A loud sound or blast, as from an explosion or gunshot — essentially an overpowering sound wave — can rarely cause a tear in your eardrum.
- Foreign objects in your ear. Small objects, such as a cotton swab or hairpin, can puncture or tear the eardrum.
- Severe head trauma. Severe injury, such as a skull base fracture, may cause the dislocation of or damage to middle and inner ear structures, including your eardrum.
Your eardrum (tympanic membrane) has two primary roles:
- Hearing. When sound waves strike it, your eardrum vibrates — the first step by which structures of your middle and inner ears translate sound waves into nerve impulses.
- Protection. Your eardrum also acts as a barrier, protecting your middle ear from water, bacteria and other foreign substances.
If your eardrum ruptures, uncommon problems can occur, especially if it fails to self-heal after three to six months. Possible complications include:
- Hearing loss. Usually, hearing loss is temporary, lasting only until the tear or hole in your eardrum has healed. The size and location of the tear can affect the degree of hearing loss.
- Middle ear infection (otitis media). A ruptured (perforated) eardrum can allow bacteria to enter the ear. If a perforated eardrum doesn't heal, a small number of people may be vulnerable to ongoing (recurrent or chronic) infections. In this small group, chronic drainage and hearing loss can occur.
Middle ear cyst (cholesteatoma). Although very rare, this cyst, which is composed of skin cells and other debris, can develop in your middle ear as a long-term result of eardrum rupture.
Ear canal debris normally travels to your outer ear with the help of ear-protecting earwax. If your eardrum is ruptured, the skin debris can pass into your middle ear and form a cyst.
A cyst in your middle ear provides a friendly environment for bacteria and contains proteins that can damage the bones of your middle ear.
Follow these tips to avoid a ruptured (perforated) eardrum:
- Get treatment for middle ear infections. Be aware of the signs and symptoms of middle ear infection, including earache, fever, nasal congestion and reduced hearing. Children with middle ear infections often are fussy and may refuse to eat. Seek prompt evaluation from your primary care doctor to prevent potential damage to the eardrum.
Protect your ears during flight. If possible, don't fly if you have a cold or an active allergy that causes nasal or ear congestion. During takeoffs and landings, keep your ears clear with pressure-equalizing earplugs, yawning or chewing gum.
Or use the Valsalva maneuver — gently pushing air into your nose, as if blowing your nose, while pinching your nostrils and keeping your mouth closed. Don't sleep during ascents and descents.
- Keep your ears free of foreign objects. Never attempt to dig out excess or hardened earwax with items such as a cotton swab, paper clip or hairpin. These items can easily tear or puncture your eardrum. Teach your children about the damage that can be done by putting foreign objects in their ears.
- Guard against explosive noise. Avoid activities that expose your ears to explosions. If your hobbies or work involves planned activities that produce explosive noise, protect your ears from unnecessary damage by wearing protective earplugs or earmuffs.
Your family doctor or ENT specialist can often determine if you have a ruptured (perforated) eardrum with a visual inspection using a lighted instrument (otoscope or microscope).
He or she may conduct or order additional tests to determine the cause of your ear symptoms or to detect the presence of any hearing loss. These tests include:
- Laboratory tests. If there's discharge from your ear, your doctor may order a laboratory test or culture to detect a bacterial infection of your middle ear.
Tuning fork evaluation. Tuning forks are two-pronged, metal instruments that produce sounds when struck. Simple tests with tuning forks can help your doctor detect hearing loss.
A tuning fork evaluation may also reveal whether hearing loss is caused by damage to the vibrating parts of your middle ear (including your eardrum), damage to sensors or nerves of your inner ear, or damage to both.
- Tympanometry. A tympanometer uses a device inserted into your ear canal that measures the response of your eardrum to slight changes in air pressure. Certain patterns of response can indicate a perforated eardrum.
- Audiology exam. This is a series of strictly calibrated tests that measure how well you hear sounds at different volumes and pitches. The tests are conducted in a soundproof booth.
Most ruptured (perforated) eardrums heal without treatment within a few weeks. Your doctor may prescribe antibiotic drops if there's evidence of infection. If the tear or hole in your eardrum doesn't heal by itself, treatment will likely involve procedures to close the tear or hole. These may include:
- Eardrum patch. If the tear or hole in your eardrum doesn't close on its own, an ENT specialist may seal it with a paper patch (or a patch made of other material). With this office procedure, your ENT doctor may apply a chemical to the edges of the tear, which can promote ear drum healing, and then apply a patch over the hole. The procedure may need to be repeated more than once before the hole closes.
- Surgery. If a patch doesn't result in proper healing or your ENT doctor determines that the tear isn't likely to heal with a patch, he or she may recommend surgery. The most common surgical procedure is called tympanoplasty. Your surgeon grafts a patch of your own tissue to close the hole in the eardrum. This procedure is done on an outpatient basis. In an outpatient procedure, you can usually go home the same day unless medical anesthesia conditions require a longer hospital stay.
Lifestyle and home remedies
A ruptured (perforated) eardrum usually heals on its own within weeks. In some cases, healing takes months. Until your doctor tells you that your ear is healed, protect it by:
- Keeping your ear dry. Place a waterproof silicone earplug or cotton ball coated with petroleum jelly in your ear when showering or bathing.
- Refraining from cleaning your ears. Give your eardrum time to heal completely.
- Avoiding blowing your nose. The pressure created when blowing your nose can damage your healing eardrum.
Preparing for an appointment
If you have signs or symptoms of a perforated eardrum, you're likely to start by seeing your family doctor or general practitioner. However, your doctor may refer you to a specialist in ear, nose and throat (ENT) disorders (otolaryngologist).
Here's some information to help you prepare for your appointment.
What you can do
Make a list ahead of time that you can share with your doctor. Your list should include:
- Symptoms you're experiencing, including any that may seem unrelated to hearing loss, fluid discharge or other ear-related symptoms
- Relevant events that may be related to your ear problems, such as a history of ear infections, recent ear injuries or head traumas, or recent air travel
- Medications, including any vitamins or supplements you're taking
- Questions for your doctor
If you think you have signs or symptoms of a ruptured eardrum, you may want to ask your doctor some of the following questions.
- Do I have a ruptured eardrum?
- What else could be causing my hearing loss and other symptoms?
- If I have a ruptured eardrum, what do I need to do to protect my ear during the healing process?
- What type of follow-up appointments will I need?
- At what point do we need to consider other treatments?
Don't hesitate to ask other questions you have.
What to expect from your doctor
Your doctor is likely to ask you a number of questions, including:
- When did you first experience symptoms?
- Did you have symptoms such as pain or vertigo that cleared up?
- Have you had ear infections?
- Have you been exposed to loud sounds?
- Have you been swimming or diving recently?
- Have you recently flown?
- Have you had head injuries?
- Do you put anything in your ear to clean it?
What you can do in the meantime
If you think that you have a ruptured eardrum, be careful to keep your ears dry to prevent infection. Don't go swimming until your condition has been evaluated and discussed with your doctor. To keep water out of your ear when showering or bathing, use a moldable, waterproof silicone earplug or put a cotton ball coated with petroleum jelly in your outer ear.
Don't put medication drops in your ear unless your doctor prescribes them specifically for infection related to your perforated eardrum.
Last Updated Oct 3, 2019
Ear discharge (otorrhea) is drainage from the ear. The drainage may be watery, bloody, or thick and whitish, like pus (purulent). Depending on the cause of the discharge, people may also have ear pain Earache Earache usually occurs in only one ear. Some people also have ear discharge or, rarely, hearing loss. Ear pain may be due to a disorder within the ear itself or a disorder in a nearby body part... read more , fever, itching, vertigo Dizziness and Vertigo Dizziness is an inexact term people often use to describe various related sensations, including Faintness (feeling about to pass out) Light-headedness Dysequilibrium (feeling off balance or... read more , ringing in the ear (tinnitus Ear Ringing or Buzzing Ringing in the ears (tinnitus) is noise originating in the ear rather than in the environment. It is a symptom and not a specific disease. Tinnitus is very common—10 to 15% of people experience... read more ), and/or hearing loss Hearing Loss Worldwide, about half a billion people (almost 8% of the world's population) have hearing loss. More than 10% of people in the United States have some degree of hearing loss that affects their... read more . Symptoms range from sudden and severe to slowly developing and mild.
Discharge may originate from the ear canal, the middle ear, or, rarely, from inside the skull.
Overall, the most common causes of ear discharge are
In some people with otitis media (usually children), the eardrum ruptures, releasing the infected material collected behind the eardrum. The hole in the eardrum almost always heals, but sometimes a small perforation remains. A perforation may also result from injury or surgery to the eardrum. When a perforation is present, people are at risk of chronic middle ear infections, which can cause ear discharge.
Serious, but rare, causes of ear discharge include
The ear canal passes through the base of the skull. If a skull fracture (from a severe head injury) involves that part of the skull, blood and/or cerebrospinal fluid may leak from the ear.
The following information can help people with ear discharge decide when a doctor's evaluation is needed and help them know what to expect during the evaluation.
In people with ear discharge, certain symptoms and characteristics are cause for concern:
Any neurologic symptoms (such as vertigo or difficulty seeing, speaking, swallowing, and/or talking)
Hearing loss in the affected ear
Redness and/or swelling of the ear or area around the ear
Diabetes or a compromised immune system
People with warning signs should see a doctor right away. People without warning signs should see a doctor as soon as possible and avoid getting water in the ear until it can be evaluated.
During the medical history, doctors ask about the following:
Activities that can affect the ear canal or eardrum (for example, swimming; insertion of objects, including cotton swabs; and use of ear drops)
Whether people have had repeated ear infections
During the physical examination, doctors focus on examining the ears, nose, throat, and neurologic system. By examining the ear canal with a light, doctors can usually diagnose perforated eardrum Eardrum Perforation A perforation is a hole in the eardrum. Eardrum perforations are caused by middle ear infections and injuries. Perforation causes sudden ear pain, sometimes with bleeding from the ear, hearing... read more , external otitis Ear Canal Infection (Swimmer's Ear) Bacteria and sometimes fungi can cause acute infection of the skin of the ear canal. Ear canal infection is caused by bacteria or, less commonly, fungi. Typical symptoms are pain and discharge... read more , foreign object Objects in the Ear Objects in the ear can be removed by flushing the ear canal with sterile water or saline or using suction, forceps, or other tools. If the foreign body cannot easily be removed, a referral to... read more , and other common causes of ear discharge. Other findings suggest the diagnosis.
Treatment for ear discharge is directed at the cause. People who have a large perforation of the eardrum are advised to keep water out of the ear. People can keep water out of the ear while showering or washing their hair by coating a cotton ball with petroleum jelly and placing it at the opening of the ear canal. Doctors can also make plugs out of silicone and place them in the canal. Such plugs are carefully sized and shaped so that they do not get lodged deep in the ear canal and cannot be removed. People who have a small perforation, such as that caused by a ventilation tube, should ask a doctor whether they need to keep water out of the ear. A cholesteatoma is treated surgically.
Acute discharge in people without longstanding ear problems or a weakened immune system is usually not dangerous and is typically due to an external ear infection or a perforated eardrum resulting from a middle ear infection.
People who have chronic ear symptoms or any symptoms besides ear discharge (particularly any neurologic symptoms) should be evaluated by a specialist.
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What are the risks of too much hydrogen peroxide in ear?
People can remove excess earwax in several different ways. Using ear drops is one easy and effective method. Many commercially available ear drops contain hydrogen peroxide.
While hydrogen peroxide can help remove excess earwax, using too much can irritate the skin inside the ear and lead to other problems.
Earwax is a waxy substance produced in the ear canal. While having earwax is generally a good thing — it protects and cleans the ear canal — too much earwax can cause issues.
According to the American Academy of Otolaryngology-Head and Neck Surgery Foundation, problems with earwax account for about 12 million visits to doctors’ offices and 8 million earwax removal procedures.
In this article, we discuss why a person might put hydrogen peroxide in their ear and what can happen if they use too much.
Why put hydrogen peroxide in the ear?
The medical term for earwax is cerumen. Hydrogen peroxide is a cerumenolytic solution that softens and dissolves earwax. A person may use hydrogen peroxide or ear drops containing hydrogen peroxide to remove excess earwax.
Usually, the ears produce enough earwax to protect and clean the ear canal.
Specialized glands, called ceruminous glands, secrete fats and acidic substances that protect the ear from infections. These secretions trap dead skin cells, dust, and dirt inside the ear. This mixture forms the waxy material commonly known as earwax.
Normally, earwax gets pushed out of the ear canal when a person moves their lower jaw while speaking or eating. However, earwax can accumulate in the ear canal if this natural cleaning process fails.
that can cause excess earwax include:
- wearing hearing aids
- wearing in-ear headphones
- cleaning the ear with cotton buds
- structural abnormalities of the ear canal
If too much earwax builds up in the ear, it can form a plug, resulting in a condition known as cerumen impaction. According to the authors of one , cerumen impaction affects an estimated 6% of the general population and more than 30% of older adults.
Excess earwax and cerumen impaction can lead to problems such as:
- hearing difficulties
- tinnitus, or ringing in the ear
- a feeling of fullness in the ear
- ear infection
- ear drainage
Risks of too much
Ear drops can contain different types of hydrogen peroxide or other substances that soften earwax.
Carbamide peroxide is a common form of hydrogen peroxide ear drops. These drops release oxygen in the earwax, causing it to bubble. The addition of oxygen softens the plug, making it easier to remove.
In general, hydrogen peroxide has a good safety profile if used properly. Most over-the-counter (OTC) hydrogen peroxide solutions contain purified water and 3% hydrogen peroxide. OTC ear drops contain 6.5% carbamide peroxide.
Hydrogen peroxide is generally safe at low concentrations. However, some people may experience side effects, :
- temporary fizzing or bubbling sensation
- bitter taste
- temporary pain in the ear
- temporary hearing loss
According to a 2018 article, hydrogen peroxide can result in residual bubbling inside the ear canal. If this happens, doctors may have difficulty examining the inner ear.
Hydrogen peroxide can cause skin irritation and blistering. It can even cause burns at concentrations over 10%.
Using too much hydrogen peroxide can irritate the skin inside the ear, leading to inflammation and earaches.
People should not use ear drops if they have an ear infection or a damaged eardrum.
People should always follow the manufacturer’s instructions or a doctor’s advice when using ear drops. They should not put more than 10 drops in the ear at one time. People can place 5–10 drops in each ear twice daily for up to 4 days.
A person can flush out excess hydrogen peroxide and earwax with warm water or a bulb syringe.
A person should consult a doctor if they experience ear discomfort or pain or if the drops do not improve their symptoms.
Hydrogen peroxide ear drops may not remove enough earwax if used alone. In this case, a person may want to consider rinsing the ear with an ear syringe.
People can find ear syringes at their local drugstores or through online retailers. They should always follow the instructions printed on the product label.
People can use other earwax softeners, such as:
- acetic acid
- docusate sodium
- sodium bicarbonate
- ear drops containing camphor, almond, or mineral oils
Place a few drops in the affected ear twice per day for 2–3 days. This will help loosen the earwax. Fill a bulb syringe with lukewarm water or a water and saline mixture.
Place the tip of the syringe near the opening of the ear and gently squeeze the bulb of the syringe. This will force the water inside the bulb into the ear.
Turn the head to the side so that any excess water and wax can flow out of the ear. People may want to perform ear irrigation over a sink or bathtub.
People should not attempt to remove wax with a foreign object, such as cotton swabs, pens, or paper clips. Doing so can push wax farther in the ear canal.
When to contact a doctor
A person may want to consider consulting a doctor if they have excess earwax that causes:
- ear pain
- hearing difficulties
- ear drainage
People should also seek medical attention if OTC or at-home treatments do not work.
Hydrogen peroxide is a common ingredient in OTC ear drops. It is a cerumenolytic solution that softens and dissolves earwax.
However, hydrogen peroxide can irritate the skin inside the ear canal if a person uses it too frequently.
BLOCKED EARS - EUSTACHIAN TUBE DYSFUNCTION (ETD)
One of the most common reasons patients come to see me is because their ears feel blocked. Most people reasonably assume that is because their ears are blocked with wax. This is often the case, however many of the patients I see have already been to see their GP who has examined their ears and told them it ‘looks normal’. There are many reasons why ears can feel blocked, but this article focusses on one of the most common causes of blocked ears - Eustachian tube dysfunction - and what can be done about it.
What is the Eustachian tube, and what does it do?
On the inside of the eardrum there is a small pocket of air. The air is continuously absorbed by the lining, generating a negative pressure. The way that the body deals with this is via the Eustachian tube. The Eustachian tube is, yes, a tube, that connects the air pocket to the very back of the nose. The Eustachian tube is usually closed, but each time you swallow or yawn, it temporarily opens and sends a little puff of air into the ear, keeping the pressures on each side of the eardrum the same.
The ear drum has a very rich nerve supply and is incredibly sensitive (one of the reasons why ear infections are so painful), so it can detect very small pressure changes, giving rise to a feeling of blockage (and other symptoms) if the Eustachian tube isn't working perfectly. It only takes some thick mucus, or a little bit of inflammation, to upset the delicate mechanism of the Eustachian tube.
What are the symptoms of Eustachian tube dysfunction?
ETD can give rise to a number of different symptoms, that can occur together or in isolation. The feeling of a blocked ear is probably the most common symptom. Some people describe it as being a feeling of water in the ear, or a pressure sensation. It is sometimes, but not always, made worse by changes in air pressure, such as going up a hill in a car, through a tunnel in a train, or being on a plane (most commonly when the plane descends to land). Other symptoms include:
- A pulsing or ringing noise in the ear (tinnitus)
- Poor or muffled hearing
- Popping or crackling noises in the ear
- Poor balance or vague feelings of dizziness
- A vague sense of disorientation, or feeling ‘as if I’m not all there’
How is Eustachian tube dysfunction diagnosed?
The diagnosis is often obvious from the history, but making a diagnosis of ETD is not always straightforward. In addition to hearing about the symptoms a patient is experiencing, an examination of the ear, nose, mouth and neck can be helpful. Examination of the back of the nose with a small flexible telescope (flexible nasendoscopy) is sometimes required to ensure there are no growths or blockages around the opening of the Eustachian tube. Hearing tests are usually required to establish if any hearing loss is present and a pressure test (tympanogram) can determine if there is a negative pressure or fluid on the inside of the ear drum. Sometimes a scan of the head is required.
What causes Eustachian tube dysfunction?
The cause of ETD is not always identified. It is much more common in young children, in whom it can lead to problems of glue ear, but it can occur at any age. People who have nasal problems such as allergic rhinitis or chronic sinusitis commonly have problems with ETD, as the inflammation in the nose often includes the Eustachian tube. Another common cause of ETD is a cough or cold. Frequently people report having had a cold that got better, but left them with a blocked ear (or ears). It usually gets better in a week or two, but can last for months afterwards.
Swellings at the back of the nose (the nasopharynx) can cause the Eustachian tubes to become blocked. Enlarged adenoids can lead to Eustachian tube problems in children, and less commonly in adults. Rarely tumours in the nasopharynx can give be the cause of ETD. If you have had a blocked ear or ears for more than six weeks, you should seek medical advice.
What can I do about it?
Unfortunately there aren’t any 100% reliable treatments, however there are a number of potential treatments. The good news is that it often gets better by itself without any treatment, although it can take many months to do so.
- Nasal salt water washes - there are many different varieties of salt water washes and sprays that can be bought over the counter, or if you prefer, you can make your own at home. These sprays can help clear thick mucus from the back of the nose in and around the opening of the Eustachian tubes.
- Steam inhalations - these work in a similar way to salt water washes
- Steroid nasal sprays or drops - these are effective at reducing inflammation in the nose and are often a good treatment for blocked nose. They can also reduce inflammation around the opening of the Eustachian tube and improve its function, although this isn't a reliable treatment.
- Antihistamines - if you have an allergy, antihistamines sometimes help.
- Gently pop the ears several times a day
- Smoking causes inflammation in the upper airways, and can lead to ETD. Stopping smoking often helps.
Are there any operations to treat Eustachian tube dysfunction?
The two main operations available treat ETD are grommet insertion and/or balloon Eustachian tube dilation
Grommets/ventilation tubes - these are small plastic tubes with a hole in the middle that can be inserted into the eardrum under a local or general anaesthetic. Air can pass directly through the grommet, bypassing the Eustachian tube. Grommets can be a very effective treatment for ETD. They usually stay in place for about 6-9 months, and the symptoms sometimes recur when the grommet falls out. In a small percentage of cases, grommets can actually make the symptoms worse. This usually occurs when an incorrect diagnosis has been made, and the symptoms are not due to ETD. The disadvantage of grommet insertion is that the ears need to be kept dry whilst the grommets are in place. There is also the risk of infection, or a hole (perforation) in the eardrum, which occurs in about one in fifty grommets that are inserted.
Eustachian tube balloon dilation (balloon tuboplasty) - this is a relatively new procedure that has been around for the last five years or so. It involves gently inserting a deflated balloon through the nose and into the opening of the Eustachian tube. The balloon is then inflated for a minute or so, gently stretching open the Eustachian tube, before it is deflated and removed. A number of research studies have been conducted looking at this treatment, almost all of which have found it is an effective treatment. However, the numbers of patients in the studies have not always been large, and the quality variable. This does mean it is difficult to say with absolute certainty that it is an effective treatment, however the early indicators are that it is a helpful treatment in about 70-80% of patients. The studies have also shown that it is a safe, treatment, and the risk of serious complications following this procedure is extremely low. Balloon tuboplasty can also be performed at the same time as grommet insertion if required.
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.Doctors, What’s Your “How the Frick Did That Happen to You” Moment?
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