A ruptured eardrum (perforated eardrum or tympanic membrane perforation) is a tear or hole in the thin tissue separating the outer ear canal from the middle ear space. The eardrum vibrates when struck by sound waves, transmitting these vibrations to the tiny bones of the middle ear, a process essential for hearing. It also serves as a protective barrier against external contaminants. A perforation compromises both sound transmission and protection.
Auditory Sensations Indicating Rupture
The immediate consequence of a ruptured eardrum is often a noticeable change in hearing, which feels like a sudden muffling of sound. This hearing loss is usually temporary, and its severity depends on the size and location of the tear. Since the eardrum cannot vibrate effectively with a hole, sound transmission is immediately less efficient.
Hearing through the damaged membrane may be described as similar to listening to poor-quality audio, sometimes likened to a crunchy or downsampled sound. Many individuals report the onset of tinnitus, the perception of sound when no external sound is present. This internal noise can manifest as a persistent ringing, buzzing, humming, or roaring sensation.
A person may perceive distinct mechanical sounds as the middle ear adjusts to new pressure dynamics. These include popping, clicking, or crackling noises, often heard when swallowing, yawning, or moving the jaw. Some people notice air rushing out of the ear when they blow their nose forcefully, which occurs because the perforation allows air to escape directly from the middle ear into the ear canal. A feeling of fullness or a blocked sensation may persist.
Other Immediate Physical Symptoms
The auditory changes are often accompanied by physical sensations that signal the perforation. A sharp, sudden ear pain is frequently the first symptom, which may then rapidly decrease or completely resolve once the membrane tears. This relief occurs because the pressure buildup behind the eardrum is released through the new opening.
Drainage from the ear, medically termed otorrhea, is a common sign following the rupture. This discharge can vary, ranging from a clear, watery liquid to a bloody discharge, or a thick, pus-filled fluid. The presence of pus or blood is common if the rupture was caused by a middle ear infection.
Disruption to the middle ear can affect the inner ear, leading to issues with balance. This may result in dizziness or vertigo, which is a sensation of spinning. Vertigo can be disorienting and may occasionally trigger nausea or vomiting.
Common Causes of Eardrum Perforation
The most frequent reason for an eardrum rupture is a middle ear infection, known as otitis media. When bacteria or viruses cause an infection, fluid and pus accumulate behind the membrane. The increasing pressure from this fluid buildup stretches the eardrum until it tears.
Another common mechanism of injury is barotrauma, involving severe pressure differences between the outside environment and the middle ear. Activities such as scuba diving, flying, or driving at high altitudes can cause this rapid pressure change. If the pressure is not equalized quickly, the resulting vacuum or shock wave can force the eardrum to rupture.
Direct trauma or injury to the ear can also cause a perforation. This includes inserting objects such as cotton swabs or hairpins too far into the ear canal. A sudden, forceful impact, such as a slap or a head injury, can generate a shockwave that tears the membrane. Extreme acoustic trauma, like being near an explosion or loud gunfire, can also cause the shockwaves necessary to rupture the eardrum.
When to Seek Medical Attention and Treatment
If a ruptured eardrum is suspected, professional medical consultation is necessary to confirm the diagnosis and prevent complications. A healthcare provider will use an otoscope, a specialized instrument with a light, to visually inspect the eardrum for a tear. Hearing tests may also be conducted to measure the extent of hearing loss and assess the eardrum’s function.
In most instances, a small tear will heal naturally without specific intervention within a few weeks to a couple of months. During this healing period, it is advised to keep the ear dry and avoid swimming or getting water into the ear canal. A doctor may prescribe antibiotic eardrops or oral antibiotics if there is evidence of an active infection or to mitigate the risk of a new infection.
If the perforation fails to close on its own, other medical interventions may be necessary. A minor procedure might involve patching the eardrum with a medicated paper material to encourage the edges of the tear to close. For larger tears or those that do not heal after several months, a surgical repair called tympanoplasty may be performed to graft the patient’s own tissue over the hole. Immediate medical attention should be sought if symptoms worsen, such as increasing pain, fever, or persistent vertigo.