A tear in the tympanic membrane, commonly known as a ruptured or perforated eardrum, can be an alarming experience. The tympanic membrane is a thin, cone-shaped tissue that separates the outer ear canal from the middle ear cavity. While the body’s natural regenerative ability often resolves the injury without long-term damage, the immediate concern is the temporary loss or muffling of sound. Understanding the structure and expected recovery trajectory is the first step toward regaining normal function.
What is a Ruptured Eardrum
A ruptured eardrum is a hole or tear in the delicate tympanic membrane, which plays an important role in both hearing and protecting the middle ear. Sound waves cause the membrane to vibrate, transmitting vibrations to the tiny bones of the middle ear, initiating the process of hearing. When a perforation occurs, this physical transmission of sound is immediately compromised.
The most frequent cause is a severe middle ear infection (otitis media), where fluid buildup creates pressure that eventually causes the membrane to burst. Other common causes include barotrauma—a sudden, intense change in air or water pressure experienced during flying or scuba diving. Direct trauma from a foreign object, such as a cotton swab, or acoustic trauma from an extremely loud, sharp noise, like an explosion, can also generate a shockwave strong enough to rupture the membrane.
Standard Recovery Timelines
The timeline for a full return of hearing is closely linked to the physical healing of the tympanic membrane, which often occurs spontaneously. For the majority of acute, non-complicated perforations, complete healing often occurs within two weeks to two months. The healing process involves the migration of epidermal cells from the edges of the perforation to close the gap.
Hearing loss associated with a ruptured eardrum is a conductive hearing loss, meaning sound waves are not effectively conducted through the outer and middle ear to the inner ear. As the hole closes, the mechanical integrity of the membrane is restored, and the ability to vibrate normally returns. Hearing improves gradually, and for smaller perforations, it can begin to stabilize and return to normal within the first few weeks following the injury.
The full functional return of hearing can sometimes lag slightly behind the physical closure of the perforation. Even after the membrane is visibly intact, residual fluid or swelling in the middle ear can continue to muffle sound for a short time. Patients should expect significant improvement within the first eight weeks, which is the window where most eardrums heal on their own. If the perforation is small and caused by minor trauma, recovery may occur within a couple of weeks.
Care and Management During Healing
Appropriate care during the recovery phase is important to prevent complications that could delay the healing of both the membrane and the return of hearing. The primary directive is to keep the affected ear completely dry to avoid introducing bacteria into the middle ear through the open perforation. This means strictly avoiding swimming and taking precautions during bathing or showering.
While showering, patients are advised to place a cotton ball coated with petroleum jelly over the ear opening to create a waterproof seal. Introducing water, especially contaminated water, carries a high risk of causing a middle ear infection, which would severely impede healing. Patients should also avoid forceful nasal blowing, as this action creates pressure in the middle ear via the Eustachian tube, potentially re-opening a healing tear.
If the rupture was caused by an active middle ear infection, a physician may prescribe oral antibiotics to clear the infection. If the cause was purely traumatic, antibiotics may not be necessary unless signs of a secondary infection develop. Over-the-counter pain relievers, like acetaminophen or ibuprofen, can be used to manage initial discomfort.
When Healing Takes Longer
In some instances, spontaneous healing does not complete within the typical two-to-three-month window, prolonging the associated hearing loss. Factors that delay closure include a particularly large perforation or a tear located at the margin of the eardrum. The presence of a persistent middle ear infection, indicated by ongoing drainage from the ear, also significantly slows the regenerative process.
If the rupture was caused by severe trauma, there is a possibility that the shock wave or foreign object also damaged the delicate ossicles—the tiny bones responsible for sound transmission—or injured the inner ear structures. Such damage can lead to a more complex and persistent hearing loss that will not resolve simply with the closure of the eardrum. When a perforation remains open for several months, typically three to six, an ear specialist will often recommend surgical intervention.
The most common procedure for a non-healing eardrum is a tympanoplasty, a surgical repair that uses a tissue graft taken from another part of the body to patch the hole. This procedure is successful in closing the perforation in the vast majority of cases, which then allows the middle ear mechanics to return to normal and hearing to be restored. If hearing loss persists after the expected window, a follow-up with an ear, nose, and throat specialist is an important step to determine if surgical repair or other management is needed.