Eardrum perforation
A hole or tear in the eardrum may follow infection, trauma or pressure injury. Many perforations heal, while persistent or recurrently infected perforations may need specialist treatment.
What is an eardrum perforation?
The eardrum, or tympanic membrane, separates the ear canal from the middle ear. A perforation is an opening in this membrane. It can occur after a middle-ear infection, injury to the ear, sudden pressure change, or insertion of an object into the ear.
The effect varies with the size and position of the perforation, the condition of the middle ear and whether infection is present.
What might you notice?
Hearing may become muffled or less clear.
Discharge can occur when infection is present.
Pain may occur with infection or at the time of injury.
Some people notice tinnitus; dizziness after trauma needs prompt assessment.
How is it evaluated?
History
Symptoms, infections, trauma, water exposure and previous ear surgery are reviewed.
Ear examination
The ear canal and eardrum are examined, usually with otoscopy or microscopy.
Hearing test
Audiometry may be advised when hearing loss is persistent, significant or treatment is being planned.
Middle-ear review
Persistent discharge or suspected deeper disease may require additional assessment.
Plan
Observation, infection control, repair or further investigation is chosen according to the findings.
Does every perforation need surgery?
No. Many recent perforations can heal without an operation. Treatment depends on the cause, duration, hearing level, recurrent infection, size and site of the perforation, and the condition of the middle ear.
When a perforation persists and causes hearing problems, repeated discharge or limits normal ear care, repair may be considered. The operation is commonly described as myringoplasty or tympanoplasty; the exact procedure depends on the ear findings.
Protect the ear
Keep contaminated water out of the affected ear and avoid inserting cotton buds, oils, drops or other objects unless specifically advised. Medicines, including ear drops, should be selected after appropriate clinical assessment because not every product is suitable when the eardrum is perforated.
Some symptoms need earlier assessment.
Seek prompt medical review for severe or worsening pain, persistent or foul-smelling discharge, marked hearing loss, significant dizziness, facial weakness, fever with worsening ear symptoms, or a perforation following significant head or ear trauma.
After an injury
Sudden major hearing loss, severe vertigo, bleeding after significant trauma, neurological symptoms or facial weakness should not be managed only through online advice. Attend an appropriate emergency or ENT service.
What should you bring?
If the problem has been present for some time, bring previous hearing tests, prescriptions, discharge summaries and any prior ear-surgery records. A clear history of how often the ear discharges and how hearing has changed is useful.
Patient information, not a diagnosis
This page provides general education. The cause of ear discharge or hearing loss cannot be determined from symptoms alone, and treatment should be individualized after examination.