15 W. Dry Creek Circle                                                                                           6169 S. Balsam Way; Suite 290
         Littleton, CO  80120-4427                                                                                                                                   Littleton, Colorado  80123
     Phone: (303)  798-1309                                                                                                                                        Fax: (303) 798-2319
Ear, Nose & Throat Center
Specialists of the Ear, Nose and Throat   /  Head and Neck Surgery  /  Facial Plastic Surgery
Evaluation  of  Dizziness  &  Vestibular Disorders

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PERFORATED EARDRUM  ( Tympanic Membrane Perforation )

A perforated eardrum is a hole or rupture in the eardrum, a thin membrane which separates the ear canal and middle ear.  The medical term for the eardrum is tympanic membrane.  The middle ear is connected to the nose by the eustachian tube, which equalizes pressure in the middle ear.  A perforated eardrum is often accompanied by decreased hearing and occasional discharge.  The 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 from:  (1)  The ear is struck squarely with an open hand.  (2)  A skull fracture.  (3) After a sudden explosion.  (4)  If an object (such as a bobby pin, Q-tip, or stick) is pushed too far into the ear canal.  (5)  As a result of hot slag (from welding or acid) entering the ear.

Middle ear infections may cause pain, hearing loss, and spontaneous rupture (tear) of the eardrum resulting in perforation.  In this circumstance there may be infected or bloody drainage from the ear.  In medical terms this is called otitis media with perforation.  

On rare occasions a small hole may remain in the eardrum after previously placed PE tubes (pressure equalizing) either fall out or are removed by the physician.  

Most eardrum perforations heal spontaneously within weeks after rupture, although 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 hearing loss.  The location of the hole (perforation) in the eardrum also affects the degree of hearing loss.  If severe trauma (e.g. skull fracture) disrupts the bones of the middle ear which transmit sound or cause injury to the inner ear structures the loss of hearing may be quite severe.  

If the perforated eardrum is due to a sudden traumatic or explosive event the hearing loss may be great and ringing in the ears (tinnitus) may be severe.  In this case the hearing usually returns partially and the ringing diminishes in a few days.  Chronic ear 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 should 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 may also 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 an otolaryngologist may choose to observe the perforation over time to see if it will close spontaneously.  They also may try to patch a cooperative patient's eardrum in the office.   If your physician feels that a paper patch will not provide prompt or adequate closure of the hole in the eardrum surgery is considered.

There is a variety of surgical techniques, but all  basically will place tissue across the perforation to allow healing.  The name of the procedure is called a tympanoplasty.  Surgery is typically quite successful in  closing the perforation permanently, and improving hearing.  This is usually done on an outpatient basis.

Your doctor will advise you regarding the proper management of a perforated eardrum.  

WHAT IS OTOLARYNGOLOGY - HEAD AND NECK SURGERY
Otolaryngology/Head and Neck Surgery is a specialty concerned with medical and surgical treatment of the ear, nose, throat and related structures of the head and neck.  This specialty encompasses cosmetic facial plastic reconstruction, surgery of benign and malignant tumors of the head and neck, management of patients with loss of hearing and balance, endoscopic examination of air and food passages, and treatment of allergic sinus, laryngeal, thyroid and esophageal disorders.  Dr. Culberson is certified by the American Board of Otolaryngology, requiring five years or more of post M.D. specialty training.

American Academy of Otolaryngology-Head and Neck Surgery, Inc. This leaflet is published as a public service. The material may be freely used for noncommercial purposes so long as attribution is given to the American Academy of Otolaryngology-Head and Neck Surgery, Inc. One Prince Street, Alexandria, VA 22314-3357