Ruptured Eardrum Symptoms, Causes, Diagnosis and Treatment

Ruptured ear drum is a perforation of tympanic membrane result from infection, trauma, loud noise or surgery.

Some of the alternate names for it are eardrum rupture, perforated eardrum and Tympanic membrane perforation.

Eardrum or Tympanic Membrane

Tympanic membrane is a thin translucent oval shaped tissue layer present deep inside the ear canal. It separated the external ear from middle and internal ear.

Picture 1 – Eardrum
Source – marshfieldclinic

Tympanic membrane is called eardrum as it looks and act as a drum.  It receives sound from outside and carries the vibration to the tiny bones or ossicles in the middle ear.

As the membrane is thin, it can be ruptured due to various reasons and exposes the middle and inner ear to outside and make the ear prone for infection.

Functions of Eardrum

Eardrum performs two important roles.

1. Act as a barrier protecting the middle and internal ear from water, foreign substances and germs.
2. Eardrum helps in hearing by receiving sound waves and transferring it to middle ear. The middle and internal ear convert the sound waves to impulses.

How do we hear?

The sound waves that comes from outside, pass through the external ear and hit the eardrum and make it to vibrate. The vibrations are passed to the bones in the middle ear and these tiny bones transfer the waves to cochlea of the inner ear where the vibrations are converted into sound signals sent to brain. The brain send impulses back to ear and as a result we hear sounds.

Is Hearing Affected by Ruptured Eardrum?

Hearing is affected greatly if the eardrum is ruptured. The intensity of hearing loss depends on the size and location of the perforation. If the bones in the inner ear is located due to trauma, the hearing loss will be almost complete. Eardrum Perforations related to chronic infections may lead to permanent hearing loss.

Is it safe to fly with Perforated Eardrum?

Ruptured Eardrum flying is safe as the perforation in the middle ear easily allows the air to pass in and out. When the plane lands, the pressure inside the ear becomes lower than that of the pressure inside the aircraft. This causes an inward pull of the eardrum which is only temporary.

Does a Ruptured Eardrum hurt?

A ruptured eardrum could be completely painless. It pains only in extreme perforations from infection and trauma.

Ruptured Eardrum Causes

The ruptured eardrum causes include;

• Otitis Media or ruptured eardrum infections– Otitis media is the inflammation of middle ear (the space between the inner ear and ear drum). Inflammation can be due to infection. The fluids produced as a result of inflammation cannot be drained out because of clogged Eustachian tubes. The pressure from this accumulated fluid may rupture the eardrum.

• Acoustic Trauma– A loud sound as in gun shot or an explosion can cause tear in tympanic membrane.

• Ear Barotrauma– Barotrauma is the physical damage to ear caused due to internal and external pressure difference. The pressure difference creates vaccum within the middle ear and the eardrum tends to move inwards. In extreme cases, the eardrum may rupture.

• Physical Trauma– Physical trauma may be caused due to insertion of cotton swabs for cleaning the ear or foreign objects that enter the ear accidentally. Other causes of physical trauma could be motor vehicle accidents, fall etc.

• Grommets– Grommets are tiny tubes placed in the ear that are used to treat glue ear or fluid in the ear. These tubes drain mucus from the ear to outside. When the Grommets get displaced from the ear, a hole is left behind in the ear.

Ruptured Eardrum in Children

Ruptured eardrum in children is a very common condition as children are regularly exposed to other children with cold and respiratory infection. Middle ear infection related eardrum perforation is reported more in children between 6 months and 1.5 years old.

Ruptured Eardrum Adults

Ruptured eardrum in adults could be mainly due to an instrument that is put inside the ear for wax removal.

Symptoms of Ruptured Eardrum

The ruptured eardrum symptoms are corrected by itself most of the times. Rarely the ruptured eardrum signs get worse and need immediate treatment.
The common symptoms of a ruptured eardrum include;

• Ruptured eardrum pain – Sharp pain or discomfort in the ears
• Drainage from the ear- If the cause of perforation is infection, there will be drainage from the ear.
• Dizziness – Dizziness accompanied by nausea and vomiting is common in perforated eardrum cases.
• Ruptured eardrum bleeding
• Tinnitus- unusual ringing sounds in the ear
• Hearing loss- Perforated eardrum hearing loss is due to the interruption in the transfer of vibrations from the external ear.

Who are at risk of Eardrum Perforation?

• Scuba divers
• People who use ear buds regularly to clean their ears
• People who received an injury to the ear

Ruptured Eardrum Diagnosis

Perforated eardrum can be easily diagnosed by using an instrument called auriscope or an otoscope. Auriscope is a small instrument with a lens and a light that allows the doctor to look into the inside of the ear. If the eardrum is rupture, the doctor will be able to see it as a small hole inside the ear and the small bones in the middle ear may be visible. If there is fluid drainage from the ear, the doctor may recommend for a lab test of the fluid to find out the organism that caused infection.

Ruptured Eardrum Treatment

In most of the cases of ruptured eardrum, treatment is not necessary as the condition correct by itself in 4-5 weeks time. Rarely, the condition gets worse and treatment becomes necessary. Not all the cases of perforated eardrum need treatment. Many of them live with a small perforation without any significant symptom or hearing loss.
Common treatment plan include;

• Medications- Antibiotics are prescribed in case of infection with ruptured eardrum drainage and Analgesics to relieve from ear pain.
• Tympanoplasty- Tympanoplasty is the surgery performed to repair the ruptured eardrum and the bones in the middle ear. Tympanoplasty procedure may require tympanic grafting in which the graft is taken from the muscle sheath of the ear lobe. Synthetic grafts are used in patients with limited graft availability.

Is Eardrop safe for Ruptured Eardrum?

Eardrop is not 100% safe for ruptured eardrum. Eardrops cause ototoxicity when used for longer period of time.

Ruptured Eardrum Prognosis

Though perforated eardrum causes discomfort and pain, it usually repairs by itself. Ruptured eardrum healing normally takes 2-3 weeks. The ruptured eardrum hearing  loss may be temporary.

• Antibiotic treatment is 100% successful and it prevents further infection and closes the perforation completely.
• If the hearing loss is not restored by itself, surgery may be needed, which may be 80-90% successful in regaining the complete hearing loss.

Eardrum Perforation Prevention

• Ear infections must not be neglected, but treated promptly and immediately.
• Do not use ear buds or other sharp objects to clean the interior of ear.

Reference :
http://www.noseandsinus.net/PDF%20Documents/Perforated%20Eardrum_PT-INFO.pdf

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002033/

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002033/