A perforated eardrum (tympanic membrane perforation) is a prick in the

eardrum In the anatomy of humans and various other tetrapods, the eardrum, also called the tympanic membrane or myringa, is a thin, cone-shaped membrane that separates the external ear from the middle ear. Its function is to transmit changes in pres ...

. It can be caused by

infection An infection is the invasion of tissue (biology), tissues by pathogens, their multiplication, and the reaction of host (biology), host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmis ...

(

otitis media Otitis media is a group of Inflammation, inflammatory diseases of the middle ear. One of the two main types is acute otitis media (AOM), an infection of rapid onset that usually presents with ear pain. In young children this may result in pullin ...

trauma Trauma most often refers to: *Psychological trauma, in psychology and psychiatric medicine, refers to severe mental and emotional injury caused by distressing events *Traumatic injury, sudden physical injury caused by an external force, which doe ...

overpressure Overpressure (or blast overpressure) is the pressure caused by a shock wave over and above normal atmospheric pressure. The shock wave may be caused by sonic boom or by explosion An explosion is a rapid expansion in volume of a given amoun ...

(loud

noise Noise is sound, chiefly unwanted, unintentional, or harmful sound considered unpleasant, loud, or disruptive to mental or hearing faculties. From a physics standpoint, there is no distinction between noise and desired sound, as both are vibrat ...

), inappropriate

ear clearing Ear clearing, clearing the ears or equalization is any of various maneuvers to equalize the pressure in the middle ear with the outside pressure, by letting air enter along the Eustachian tubes, as this does not always happen automatically whe ...

, and changes in middle ear pressure. An

otoscope An otoscope or auriscope is a medical device used by healthcare professionals to examine the ear canal and eardrum. This may be done as part of routine Physical examination, physical examinations, or for evaluating specific ear complaints, such ...

can be used to view the eardrum to diagnose a perforation. Perforations may heal naturally or require surgery.

Presentation

A perforated eardrum leads to

conductive hearing loss Conductive hearing loss (CHL) is a type of hearing impairment that occurs when sound waves are unable to efficiently travel through the outer ear, tympanic membrane (eardrum), or middle ear structures such as the ossicles. This blockage or dysfun ...

, which is usually temporary. Other symptoms may include

tinnitus Tinnitus is a condition when a person hears a ringing sound or a different variety of sound when no corresponding external sound is present and other people cannot hear it. Nearly everyone experiences faint "normal tinnitus" in a completely ...

ear pain Ear pain, also known as earache or otalgia, is pain in the ear. Primary ear pain is pain that originates from the ear. Secondary ear pain is a type of referred pain, meaning that the source of the pain differs from the location where the pain is ...

vertigo Vertigo is a condition in which a person has the sensation that they are moving, or that objects around them are moving, when they are not. Often it feels like a spinning or swaying movement. It may be associated with nausea, vomiting, perspira ...

, or a discharge of

mucus Mucus (, ) is a slippery aqueous secretion produced by, and covering, mucous membranes. It is typically produced from cells found in mucous glands, although it may also originate from mixed glands, which contain both Serous fluid, serous and muc ...

Nausea Nausea is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to vomit. It can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of the throat. Over 30 d ...

and/or

vomiting Vomiting (also known as emesis, puking and throwing up) is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting can be the result of ailments like food poisoning, gastroenteritis, pre ...

secondary to vertigo may occur.

Causes

A perforated eardrum can have one of many causes, such as: *

Infection An infection is the invasion of tissue (biology), tissues by pathogens, their multiplication, and the reaction of host (biology), host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmis ...

(

). This infection may then spread through the middle ear and may reoccur. *

Trauma Trauma most often refers to: *Psychological trauma, in psychology and psychiatric medicine, refers to severe mental and emotional injury caused by distressing events *Traumatic injury, sudden physical injury caused by an external force, which doe ...

. This may be caused by trying to clean

ear wax In vertebrates, an ear is the organ (anatomy), organ that enables hearing and (in mammals) Sense of balance, body balance using the vestibular system. In humans, the ear is described as having three parts: the outer ear, the middle ear and ...

with sharp instruments. It may also occur due to

surgical complication A complication in medicine, or medical complication, is an unfavorable result of a disease, health condition, or treatment. Complications may adversely affect the prognosis, or outcome, of a disease. Complications generally involve a worsening in ...

s. *

Overpressure Overpressure (or blast overpressure) is the pressure caused by a shock wave over and above normal atmospheric pressure. The shock wave may be caused by sonic boom or by explosion An explosion is a rapid expansion in volume of a given amoun ...

(loud

shockwave In physics, a shock wave (also spelled shockwave), or shock, is a type of propagating disturbance that moves faster than the local speed of sound in the medium. Like an ordinary wave, a shock wave carries energy and can propagate through a me ...

from an

explosion An explosion is a rapid expansion in volume of a given amount of matter associated with an extreme outward release of energy, usually with the generation of high temperatures and release of high-pressure gases. Explosions may also be generated ...

). * Inappropriate

. * Flying with a severe

cold Cold is the presence of low temperature, especially in the atmosphere. In common usage, cold is often a subjectivity, subjective perception. A lower bound to temperature is absolute zero, defined as 0.00K on the Kelvin scale, an absolute t ...

, due to changes in air pressure and blocked

Eustachian tube The Eustachian tube (), also called the auditory tube or pharyngotympanic tube, is a tube that links the nasopharynx to the middle ear, of which it is also a part. In adult humans, the Eustachian tube is approximately long and in diameter. It ...

s resulting from the cold. This is especially true on landing.

Diagnosis

can be used to look at the

ear canal The ear canal (external acoustic meatus, external auditory meatus, EAM) is a pathway running from the outer ear to the middle ear. The adult human ear canal extends from the auricle to the eardrum and is about in length and in diameter. S ...

. This gives a view of the

and

, so that a perforated eardrum can be seen.

Tympanometry Tympanometry is an acoustic evaluation of the condition of the middle ear eardrum (tympanic membrane) and the conduction bones by creating variations of air pressure in the ear canal. Tympanometry is an objective test of middle-ear function. It ...

may also be used.

Treatment

Conservative management

A perforated eardrum often heals naturally. It may heal in a few weeks or may take up to a few months.

Surgery

Some perforations require surgical intervention. This may take the form of a paper patch to promote healing (a simple procedure by an

ear, nose and throat specialist Otorhinolaryngology ( , abbreviated ORL and also known as otolaryngology, otolaryngology–head and neck surgery (ORL–H&N or OHNS), or ear, nose, and throat (ENT)) is a surgical subspecialty within medicine that deals with the surgical an ...

), or surgery (

tympanoplasty Tympanoplasty is the surgical operation performed to reconstruct hearing mechanism of middle ear. Classification Tympanoplasty is classified into five different types, originally described by Horst Ludwig Wullstein (1906–1987) in 1956.Wullste ...

). However, in some cases, the perforation can last several years and will be unable to heal naturally. For patients with persistent perforation, surgery is usually undertaken to close the perforation. The objective of the surgery is to provide a platform of sort to support the regrowth and healing of the tympanic membrane in the two weeks post-surgery period. There are two ways of doing the surgery: # Traditional tympanoplasty, usually using the microscope and performed through a 10 cm incision behind the ear lobe. This technique was introduced by Wullstien and Zollner and popularized by the Jim Sheehy at the House Ear Institute. # Endoscopic tympanoplasty, usually using the endoscope through the ear canal without the need for incision. This technique was introduced and popularized by Professor Tarabichi of TSESI: Tarabichi Stammberger Ear and Sinus Institute. The success of surgery is variable based on the cause of perforation and the technique being used. Predictors of success include traumatic perforation, dry ear, and central perforations. Predictors of failure includes young age and poor Eustachian tube function. The use of minimally invasive endoscopic technique does not reduce the chance of successful outcome. Hearing is usually recovered fully, but chronic infection over a long period may lead to permanent hearing loss. Those with more severe ruptures may need to wear an ear plug to prevent water contact with the ear drum.

References

External links

{{Nonmusculoskeletal injuries of head, neck, and thorax Diseases of middle ear and mastoid Injuries of head Otorhinolaryngology Otology