Tympanic Membrane Perforation

A tear or hole in the eardrum can happen from an infection, injury, or sudden pressure change, often causing pain, drainage, or hearing loss—but most perforations heal on their own within weeks.

Table of contents

• What is Tympanic Membrane Perforation?
• Signs and Symptoms
• What Causes a Perforated Eardrum?
• How It Is Diagnosed
• Treatment Options
• Possible Complications
• How to Protect Your Ears
• What to Expect

What is Tympanic Membrane Perforation?

ruptured eardrum, perforated eardrum

A tympanic membrane perforation, also called a ruptured or perforated eardrum, is a hole or tear in the thin tissue that separates your outer ear from your middle ear.^[1] The eardrum is a delicate membrane about the size of your first fingernail that plays an important role in hearing.^[2] When sound waves reach your ear, they make the eardrum vibrate, and these vibrations travel to tiny bones in your middle ear and then to your inner ear, where your brain recognizes them as sound.^[1]

When there is a hole in the eardrum, it cannot vibrate properly, which can affect your hearing. The hole also allows water and germs to enter the middle ear more easily, raising the risk of infection.^[5] A perforation can range from a very small puncture to a large tear involving much of the eardrum.^[18]

This condition can happen to anyone at any age, though it is more common in children, often as a result of ear infections. As people get older, injury becomes a more likely cause.^[1] Men experience tympanic membrane perforation more often than women.^[1]

Signs and Symptoms

You might not realize your eardrum has ruptured right away, especially if nothing directly hit your ear. Many people first notice changes in their hearing or fluid draining from the ear.^[5]

Common symptoms of a perforated eardrum include:

• Ear pain that often comes on suddenly and may go away quickly once the eardrum tears^[2]
• Fluid draining from the ear, which may look like mucus, pus, or have blood in it^[2]
• Sudden hearing loss or muffled hearing^[2]
• Tinnitus, which is a ringing, buzzing, or humming sound in the ear^[2]
• A feeling of spinning or dizziness, also called vertigo^[2]
• Nausea or vomiting that can come from vertigo^[2]
• A feeling of fullness or pressure in the ear^[8]

The level of hearing loss depends on the size and location of the hole. Larger perforations generally cause more hearing problems.^[18] If an explosion has torn the eardrum, you may have ringing in your ears for several days along with hearing loss.^[18]

What Causes a Perforated Eardrum?

There are many different ways the eardrum can tear or develop a hole. The most common cause of a perforated eardrum is a middle ear infection.^[5] When fluid builds up behind your eardrum during an infection, it creates pressure that can make the membrane tear or pop.^[1] With acute otitis media (middle ear infection), the risk of a hole forming increases with repeated infections and infections caused by certain bacteria.^[1]

Other common causes include:

• Direct trauma: Inserting objects like cotton swabs, bobby pins, or pencils too far into the ear canal can puncture the eardrum.^[1] A hard blow to the ear or head, such as from a fall or slap, can also cause rupture.^[5]
• Barotrauma: Sudden changes in air pressure during activities like flying, scuba diving, or exposure to an explosion can cause the eardrum to burst when air gets trapped in the middle ear.^[1]
• Extremely loud sounds: Very loud noises from explosions, gunfire, or other sources can generate enough pressure to damage or perforate the eardrum.^[1]
• Head injury: Severe head trauma from accidents can damage structures in the ear, leading to a perforated eardrum.^[18]
• Previous ear surgery: Sometimes after ear tubes are removed, the small hole left behind does not heal properly.^[4]

Rarely, lightning strikes have also been reported as a cause of eardrum perforation.^[1]

How It Is Diagnosed

If you think you have a perforated eardrum, a doctor can usually confirm it with a simple examination. Your doctor will look inside your ear using an instrument called an otoscope, which shines a light into your ear canal so the eardrum can be seen.^[5] Most perforations can be identified this way. Small holes may require examination with an otomicroscope for better visibility.^[7]

Additional tests may be performed to understand the extent of the problem:

• Hearing test (audiometry): This measures how much hearing loss there is by checking your response to sounds of different tones and intensities.^[4] A hearing test is necessary before any repair attempt.^[7]
• Tympanometry: This test measures how the eardrum responds to small changes in air pressure and can help confirm a perforation.^[4]
• Tuning fork tests: Simple tests with tuning forks can help find hearing loss and identify whether the problem is in the middle ear or inner ear.^[5]

If the doctor suspects a perforation but cannot see it clearly, he or she may confirm the diagnosis by blowing pressurized air into your ear using a special machine.^[18] If there is drainage from the ear, a lab test might be done to check for bacterial infection.^[1]

Treatment Options

Most perforated eardrums heal on their own without any treatment, especially small holes. The healing process typically takes a few weeks, though some cases can take up to two months.^[18] During this time, it is important to keep the ear dry and avoid further injury.^[16]

Self-Care and Observation

For many small perforations, your doctor may recommend simply monitoring the healing process.^[8] During this time, you should:

• Keep water out of the ear by using a cotton ball coated with petroleum jelly when showering^[16]
• Avoid swimming or use waterproof earplugs^[16]
• Not insert anything into the ear canal, including cotton swabs^[16]
• Avoid blowing your nose, which can cause pressure changes that disrupt healing^[18]

Medications

If the perforation is caused by an infection, your doctor may prescribe antibiotics, either as pills or ear drops, to treat the infection and prevent complications during healing.^[5] However, certain antibiotic ear drops containing gentamicin, neomycin sulfate, or tobramycin should be avoided because they can be harmful to the inner ear when exposed to the middle ear through a perforation.^[7]

Over-the-counter pain relievers such as acetaminophen or ibuprofen can help manage pain and inflammation.^[16] Placing a warm cloth or heating pad set on low against the ear may also help ease pain.^[16]

Office Procedures

For perforations that do not heal on their own after about two months, several repair options may be considered.^[18] Some patients with small, dry holes that do not involve certain key areas of the eardrum may be candidates for office-based treatments.^[7]

The simplest office procedure involves freshening the edges of the perforation and applying a small paper patch to provide a scaffold for healing.^[7] Another option is a fat-plug tympanoplasty, where a small piece of fat is taken from the earlobe under local anesthesia and tucked into the perforation.^[7]

Surgery

Larger perforations or those that fail to heal with simpler treatments may require surgery. The most common surgical procedure is called tympanoplasty.^[11] During this operation, the surgeon creates a patch using tissue taken from the covering of the muscle above your ear, called fascia, or from cartilage.^[9] This graft material is held against the edges of the perforation until healing occurs, which generally takes several weeks.^[9]

Many tympanoplasty procedures can be performed through the ear canal without any visible incisions, though some require an approach from behind the ear to harvest graft material or access the perforation.^[4] This is typically an outpatient procedure that takes 90 minutes to two hours, and most patients can return to work within a few days.^[21] The success rate for eardrum repair surgery is around 90 percent.^[7]

Possible Complications

While most perforated eardrums heal without problems, complications can occur, especially if the hole does not close on its own.^[1] The eardrum acts as a barrier to protect the middle ear, and when it is torn, germs, water, and debris can enter more easily, raising the risk of infection.^[5]

Possible complications include:

• Chronic otitis media: Ongoing middle ear infections can develop because the protective barrier is broken^[1]
• Persistent hearing loss: If the perforation does not heal, hearing loss may continue^[5]
• Cholesteatoma: Skin from the outer surface of the eardrum can migrate through the perforation into the middle ear and accumulate, forming an abnormal skin growth that can damage ear structures and cause infection^[1]
• Mastoiditis: Infection can spread to the mastoid bone behind the ear^[1]
• Dizziness or balance problems^[5]
• Recurrent drainage from the ear^[4]

If the perforated eardrum becomes infected during the healing phase, it is less likely to close on its own.^[18] Exposure to water or further trauma can slow healing.^[18]

How to Protect Your Ears

There are several simple steps you can take to reduce your risk of developing a perforated eardrum:

• Treat ear infections promptly: See a healthcare provider if you have signs of a middle ear infection, such as ear pain, stuffy nose, fever, or trouble hearing that lasts more than a few days.^[5] Getting treatment early can prevent complications. Children can also receive immunizations against common bacteria that cause middle ear infections.^[18]
• Clean your ears safely: Do not insert cotton swabs, bobby pins, or other objects into your ear canal, as this can tear the eardrum.^[5] Use a clean cloth to gently wipe only the outside of your ear.^[5]
• Protect against pressure changes: During air travel, chew gum or yawn during takeoff and landing to help equalize pressure. You can also wear special earplugs designed for flying.^[5]
• Protect from loud noises: Use earplugs or hearing protection if you will be near gunfire, explosions, or other very loud sounds.^[5]
• Avoid direct contact with people who have colds or flu: This can help reduce the risk of ear infections. Minimize exposure to tobacco smoke and allergens as well.^[18]

If you already have a perforated eardrum, keeping the ear dry is essential to prevent infection and promote healing. Use earplugs when swimming in lakes, rivers, or oceans, or when diving into pools.^[4]

What to Expect

Overall, tympanic membrane perforation has a favorable outlook with a small risk of complications.^[1] Most small perforations heal completely on their own within a few weeks without any intervention.^[18] Even larger tears can heal spontaneously, particularly when caused by trauma such as cotton swab use.^[7]

After a perforation heals—either on its own or with treatment—hearing often returns to normal or near-normal levels, especially for mid-range frequencies.^[23] However, healing time can be affected by several factors, including the size and location of the perforation, whether infection develops, and individual health conditions such as diabetes or smoking.^[21]

It is important to have follow-up appointments with your doctor to check whether the eardrum has healed properly.^[16] If symptoms persist or worsen, or if hearing does not improve, further evaluation and treatment may be needed.^[16] You should contact your doctor if you experience signs of infection such as increased pain, fever, or pus draining from the ear.^[16]

With proper care and treatment when needed, most people with perforated eardrums recover fully and return to normal hearing and ear health.^[1]