Symptoms and causes

Symptoms

Signs and symptoms of a ruptured eardrum may include:

  • Ear pain that may subside quickly
  • Clear, pus-filled or bloody drainage from your ear
  • Hearing loss
  • Ringing in your ear (tinnitus)
  • Spinning sensation (vertigo)
  • Nausea or vomiting that can result from vertigo

When to see a doctor

Call your doctor if you experience any of the signs or symptoms of a ruptured eardrum or pain or discomfort in your ears. Your middle and inner ears are composed of delicate mechanisms that are sensitive to injury or disease. Prompt and appropriate treatment is important to preserve your hearing.

Causes

Causes of a ruptured, or perforated, eardrum may include:

  • Middle ear infection (otitis media). A middle ear infection often results in the accumulation of fluids in your middle ear. Pressure from these fluids can cause the eardrum to rupture.
  • Barotrauma. Barotrauma is stress exerted on your eardrum when the air pressure in your middle ear and the air pressure in the environment are out of balance. If the pressure is severe, your eardrum can rupture. Barotrauma is most often caused by air pressure changes associated with air travel.

    Other events that can cause sudden changes in pressure — and possibly a ruptured eardrum — include scuba diving and a direct blow to the ear, such as the impact of an automobile air bag.

  • Loud sounds or blasts (acoustic trauma). A loud sound or blast, as from an explosion or gunshot — essentially an overpowering sound wave — can cause a tear in your eardrum.
  • Foreign objects in your ear. Small objects, such as a cotton swab or hairpin, can puncture or tear the eardrum.
  • Severe head trauma. Severe injury, such as skull fracture, may cause the dislocation or damage to middle and inner ear structures, including your eardrum.

Complications

Your eardrum (tympanic membrane) has two primary roles:

  • Hearing. When sound waves strike it, your eardrum vibrates — the first step by which structures of your middle and inner ears translate sound waves into nerve impulses.
  • Protection. Your eardrum also acts as a barrier, protecting your middle ear from water, bacteria and other foreign substances.

If your eardrum ruptures, complications can occur while your eardrum is healing or if it fails to heal. Possible complications include:

  • Hearing loss. Usually, hearing loss is temporary, lasting only until the tear or hole in your eardrum has healed. The size and location of the tear can affect the degree of hearing loss.
  • Middle ear infection (otitis media). A perforated eardrum can allow bacteria to enter your ear. If a perforated eardrum doesn't heal or isn't repaired, you may be vulnerable to ongoing (chronic) infections that can cause permanent hearing loss.
  • Middle ear cyst (cholesteatoma). A cholesteatoma is a cyst in your middle ear composed of skin cells and other debris.

    Ear canal debris normally travels to your outer ear with the help of ear-protecting earwax. If your eardrum is ruptured, the skin debris can pass into your middle ear and form a cyst.

    A cholesteatoma provides a friendly environment for bacteria and contains proteins that can damage bones of your middle ear.

Nov. 10, 2016
References
  1. Perforated eardrum. American Academy of Otolaryngology — Head and Neck Surgery. http://www.entnet.org/content/perforated-eardrum. Accessed Sept. 19, 2016.
  2. Evans AK, et al. Evaluation and management of middle ear trauma. http://www.uptodate.com/home. Accessed Sept. 19, 2016.
  3. Lalwani AK. Temporal bone trauma. In: Current Diagnosis & Treatment in Otolaryngology--Head & Neck Surgery. 3rd ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com. Accessed Sept. 19, 2016.
  4. Vernick DM. Ear barotrauma. http://www.uptodate.com/home. Accessed Sept. 19, 2016.
  5. Traumatic perforation of the tympanic membrane. Merck Manual Professional Version. https://www.merckmanuals.com/professional/ear,-nose,-and-throat-disorders/middle-ear-and-tympanic-membrane-disorders/traumatic-perforation-of-the-tympanic-membrane. Accessed Sept. 20, 2016.