A perforated eardrum (tympanic membrane) is a hole or rupture in the eardrum, a thin membrane that separates the ear canal and the middle ear. A perforated eardrum is often accompanied by decreased hearing and discharge. Pain is usually not persistent.
Causes Of Eardrum Perforation
The causes of perforated eardrum are usually from trauma or infection. A perforated eardrum can occur:
- If the ear is struck squarely with an open hand or a wave of water (at the ocean)
- If an object such as a cotton-tipped applicator, hair pin or pen is pushed far into the ear canal
- After a severe middle ear infection (otitis media)*
- With a skull fracture
- After a sudden explosion
- As a result of hot welding slag or acid entering the ear canal
*Middle ear infections may cause pain, hearing loss, and spontaneous rupture (tear) of the ear-drum resulting in a perforation. In this circumstance, there maybe infected or bloody drainage from the ear. This is called otitis media with perforation.
On rare occasions a small hole may remain in the eardrum after a previously placed PE (pressure equalizing) tube either falls out or is removed by the physician.
Most eardrum perforations heal spontaneously within weeks after rupture, although some may take up to several months. During the healing process the ear must be protected from water and trauma. Those eardrum perforations which do not heal on their own may require surgery.
Effects On Hearing From Perforated Eardrum
Usually, the larger the perforation, the greater the loss of hearing. The location of the hole (perforation) in the eardrum also effects the degree of hearing loss. If severe trauma (e.g. skull fracture) disrupts the bones in the middle ear which transmit sound or causes injury to the inner ear structures, the loss of hearing maybe quite severe.
If the perforated eardrum is due to a sudden traumatic or explosive event, the loss of hearing can be great and ringing in the ear (tinnitus) may be severe. In this case the hearing usually returns partially, and the ringing diminishes in a few days. Chronic infection as a result of the perforation can cause major hearing loss.
Treatment Of The Perforated Eardrum
Before attempting any correction of the perforation, a hearing test will be performed. The benefits of closing a perforation include prevention of water entering the ear while showering, bathing, or swimming (which could cause ear infection), improved hearing, and diminished tinnitus. It also may prevent the development of cholesteatoma (skin cyst in the middle ear), which can cause chronic infection and destruction of ear structures.
If the perforation is very small, Dr. Chandrasekhar may choose to observe the perforation over time to see if it will heal on its own. As a temporizing measure, she may, working under a microscope, touch the edges of the eardrum with a chemical to stimulate growth and then place a thin paper patch on the eardrum. Usually with closure of the tympanic membrane improvement in hearing is noted. Several applications of a patch (up to three or four) may be required before the perforation doses completely. If Dr. Chandrasekhar feels that a paper patch will not provide prompt or adequate closure of the hole in the eardrum, or attempts with paper patching do not promote healing, surgery is considered.
There are a variety of surgical techniques, but all involve the placement of your own body’s tissue across the perforation allowing healing. The name of this procedure is called tympanoplasty. When necessary, the middle ear bones are repaired or replaced at the same time. Tympanoplasty surgery is over 95% successful in closing the perforation permanently, and improving hearing. It is usually done on an outpatient basis.
Postoperative instructions following tympanoplasty are available in the Instructions portion of this website.
(adapted from http://www.entlink.net/healthinfo/ears/perforation.cfm)
You can read more about Tympanic Membrane Perforation and Tympanoplasty in Dr. Chandrasekhar’s published literature:
- Chandrasekhar SS, House JW, Devgan U: Pediatric tympanoplasty: a 10-year experience. Arch Otolaryngol-Head Neck Surg 1995 Aug:121(8):873-8.
- De La Cruz A, Chandrasekhar SS: Reconstruction Surgery of the Ear: Auditory Canal and Tympanum. In: Otolaryngology Head & Neck Surgery, 3rd Edition, Vol. 5. CW Cummings, JM Fredrickson, LA Harker, CJ Krause, MA Richardson, DE Schuller, editors, 1999.