A perforated eardrum often causes sudden ear pain and itching, along with muffled hearing and, in some cases, bleeding from the ear.
Small perforations usually heal on their own without treatment, while larger tears may need antibiotics. If the eardrum doesn’t heal naturally, a minor surgical procedure might be required.
The eardrum (tympanic membrane) separates the outer ear from the middle ear and plays an important role in hearing. If it stays perforated and isn’t treated properly, it can lead to longer-term hearing loss.
Main symptoms
The main symptoms of a perforated eardrum are:
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Intense ear pain that starts suddenly;
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Sudden hearing loss;
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Itching in the ear;
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Bleeding from the ear;
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Pus draining from the ear, due to the presence of viruses or bacteria;
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Ringing in the ear (tinnitus);
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Possibly fever, dizziness, and vertigo.
If you think you might have a perforated eardrum, it’s best to see your primary care provider or an ear, nose, and throat (ENT) specialist. According to the CDC, pus, discharge, or fluid coming from the ear and hearing loss are reasons to seek medical care.
You should also get checked right away if you experience a significant decrease or total loss of hearing in one ear.
Confirming a diagnosis
A perforated eardrum is diagnosed by a primary care provider or an ENT specialist based on symptoms and a physical exam of the ear. The provider typically uses a special device called an otoscope to look at the eardrum and check whether there is a hole.
Along with confirming the perforation, the provider may look for signs of infection. If an infection is present, it may need treatment so the eardrum can heal properly.
The provider may also order tests such as a culture of the ear drainage to identify which bacteria may be involved. Hearing tests like audiometry or tympanometry may also be requested to assess hearing changes and possible fluid behind the eardrum.
Possible causes
The main causes of a perforated eardrum are:
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A complication of ear infections, such as acute otitis media or otitis externa;
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Barotrauma, caused by a sudden pressure change during airplane travel or scuba diving;
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Head trauma;
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Acoustic trauma due to loud sounds or explosions;
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Inserting objects into the ear, which especially affects babies and children, often due to improper cotton swab use;
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Attempting to remove earwax or a foreign object from the ear.
A perforated eardrum can also happen after prior ear surgery, or with more severe middle ear or outer ear infections.
Treatment options
Treatment for a perforated eardrum should be guided by your primary care provider or an ENT doctor. In general, it’s recommended to keep the ear dry to reduce the risk of infection.
To do this, you can place a small piece of cotton in the ear while showering and avoid the beach or swimming pool. It’s also commonly recommended not to blow your nose and not to rinse or flush the ear.
If there are signs of an ear infection or the eardrum has completely ruptured, a healthcare provider may prescribe antibiotic ear drops, such as ofloxacin or ciprofloxacin-based drops, sometimes combined with a corticosteroid, depending on your specific condition.
Oral antibiotics (tablets) or liquid antibiotics (syrups) may also be recommended, such as amoxicillin or amoxicillin + clavulanate. These medications usually clear the infection within 8 to 10 days. In some cases, a surgical procedure called tympanoplasty may be needed to repair the eardrum.
Indications for surgery
Surgery to repair a perforated eardrum, also called tympanoplasty, is usually recommended when the membrane does not fully heal within 2 months after the rupture.
Surgery may also be indicated when, in addition to the perforation, there is a fracture or damage to the small bones that are part of the ear. This is more common after an accident or head injury, for example.