The eardrum, also known as the tympanic membrane, is an important structure in the ear. It vibrates when sound waves strike it, transmitting these vibrations to the small bones in the middle ear, which is essential for hearing. Changes in its appearance, such as a dark or black discoloration, can be a source of concern.
What a Healthy Eardrum Looks Like
A healthy eardrum appears pearly gray or shiny pearly-white. It is slightly translucent, allowing a view of certain middle ear structures, such as the malleus bone (hammer). The malleus gently pulls the eardrum inward, creating a concave shape and a light reflection known as the light reflex. The ear canal is skin-colored with small hairs and may contain yellowish-brown earwax.
Common Reasons for a Dark Eardrum
Earwax (Cerumen) Buildup
Earwax (cerumen) buildup is a common reason for a dark eardrum. It ranges from off-white to black, with older wax often darker due to oxidation. Excessive or impacted earwax can obscure the eardrum, making it appear dark or black. This occurs if the ear’s natural self-cleaning is inefficient, or if objects like cotton swabs push wax deeper, compacting it.
Blood or Old Blood
Blood in the middle ear (hemotympanum) can make the eardrum appear dark red, purple, or dark blue. Fresh blood is bright red, while older, deoxygenated blood is darker. This can result from blunt head trauma (e.g., temporal bone fracture), bleeding disorders, or anticoagulant medications. Blood can also enter the middle ear from nasal packing after nosebleeds or surgery via retrograde flow through the Eustachian tubes.
Foreign Body
A dark foreign object in the ear canal can be mistaken for a dark eardrum or press against it, causing discoloration. Common foreign bodies, especially in children, include small toys, food, or insects. While more common in the external ear canal, an object (even a live insect) can rarely enter the middle ear through an existing eardrum perforation, appearing dark. Such objects can cause irritation, pain, or infection.
Fungal Infection (Otomycosis)
Fungal infections of the outer ear canal (otomycosis) can cause a dark eardrum. More common in warm, humid climates, these infections can produce dark, fuzzy spores or debris on the eardrum or within the ear canal. Aspergillus niger, for example, can cause fine, black, coal-dust-like spores. Symptoms often include intense itching, earache, inflammation, and sometimes dark discharge.
Perforation with Debris
An eardrum perforation (a hole or tear) can contribute to a dark appearance, especially if accompanied by dried blood, pus, or debris. A perforated eardrum allows bacteria and other substances to more easily enter the middle ear, increasing infection risk. In rare, long-term cases, a perforation can allow skin cells and debris from the ear canal to enter the middle ear, forming a cholesteatoma cyst, which may also appear dark.
Melanin Deposits
Rarely, benign melanin deposits can occur on the eardrum, creating a dark spot or area. Melanin is a natural pigment found in the body. While its presence in the inner ear is known, its role on the eardrum, especially regarding inflammation, is still being explored.
When to Seek Medical Attention
If your eardrum appears dark or black, consult a healthcare professional for diagnosis. While dark earwax is often harmless, other causes may require medical intervention. Seek medical attention if darkening is accompanied by other concerning symptoms.
Symptoms warranting immediate evaluation include severe or sudden ear pain, pus-filled or bloody ear discharge, and any hearing loss. Ringing in the ears (tinnitus), ear fullness, dizziness (vertigo), nausea, or fever also indicate prompt medical assessment. A doctor can use an otoscope to examine the eardrum, determine the cause, and ensure appropriate management and prevent complications.