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Ruptured Eardrum

Definition


Disease: Ruptured Eardrum Ruptured Eardrum
Category: Ear, nose, larynx diseases
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Disease Definition:

A hole or tear in the eardrum, which is the thin drum-like tissue that separates the ear canal from the middle ear, is called a ruptured eardrum.

The middle ear may become vulnerable to infections or other injury and a person may lose his/her hearing as a result of a ruptured eardrum.

Without treatment and within a few weeks, a ruptured eardrum usually heals. Surgical repair or a procedure to promote healing of a ruptured eardrum may be needed sometimes.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

A ruptured eardrum may cause some of these signs and symptoms:

 

  • Spinning sensation (vertigo) that usually goes away quickly
  • Nausea or vomiting that can result from vertigo
  • Clear, pus-filled or bloody drainage from the ear
  • Sharp, sudden ear pain that usually disappears quickly
  • Ringing in the ear (tinnitus)
  • Hearing loss


To preserve healing, prompt and appropriate treatment is important. When experiencing any of the signs or symptoms of a ruptured eardrum or any pain or discomfort in the ears, a person should call the doctor because the middle and inner ears are composed of delicate mechanisms that are sensitive to injury or disease.

Causes:

There are two primary functions of the eardrum (tympanic membrane):

Protective role:
The eardrum acts as a barrier protecting the middle ear from water, bacteria and other foreign substances.

Hearing role:
The eardrum vibrates, which is the first step by which structures of the middle and inner ear translate sound waves into nerve impulses, when sound waves strike it.

The causes of a ruptured eardrum, known as a perforated tympanic membrane, may include:

Foreign objects in the ear:
The eardrum may be punctured or torn due to small objects such as a bobby pin or a cotton swab.

Severe head trauma:
The dislocation or damage to inner ear structures, including the eardrum, may be caused by severe injury such as skull fracture.

Barotrauma:
When the air pressure in the middle ear and the air pressure in the environment are out of balance, stress exerts on the eardrum, causing barotrauma. The eardrum can rupture if the pressure is severe. Because barotrauma is most often caused by air pressure changes associated with air travel, it's also called airplane ear. Scuba diving and a direct blow to the ear, such as the impact of an automobile air bag are other events that can cause sudden changes in pressure, and possibly a ruptured eardrum.

Middle ear infection (otitis media):
The accumulation of fluids in the middle ear is often the result of a middle ear infection. The eardrum can rupture because of the pressure from these fluids.

Loud sounds or blasts (acoustic trauma):
A tear in the eardrum can be caused by a loud sound or blast, as from an explosion or gunshot — essentially an overpowering sound wave.

Complications

Complications:

While the eardrum is healing, or if it fails to heal, complications can occur. Possible complications include:

Middle ear cyst (cholesteatoma):
A cyst in the middle ear composed of skin cells, the ear canal's normal waxy discharge (cerumen) and other debris, is what a cholesteatoma is made up of. In the form of earwax, this debris normally migrates to the outer ear. The debris can pass into the middle ear and form a cyst if the eardrum is ruptured. Cholesteatoma contains proteins that can damage bones of the middle ear, and provides a friendly environment for bacteria.

Hearing loss:
Lasting only until the tear or hole in the eardrum has healed, hearing loss is usually temporary. The degree of hearing loss may be affected by the size and location of the tear.

Middle ear infection (otitis media):
Bacteria can be allowed to enter the ear due to a ruptured eardrum. A person may be vulnerable to ongoing (chronic) infections that can cause permanent hearing loss if a ruptured eardrum doesn't heal or isn't repaired.

Treatments:

Within a few weeks and without treatment, most ruptured eardrums heal. Procedures to close the perforation will be involved in the treatment if the tear or hole in the eardrum doesn't heal by itself. These procedures may include:

Eardrum patch:
An ENT specialist may seal the tear or hole in the eardrum with a paper patch if this tear or hole doesn't close on its own. The ENT will apply a chemical to the edges of the tear to stimulate growth and then apply a paper patch over the hole. Before the hole closes, the procedure may need to be repeated three or four times. This is usually done in the doctor’s office.

Surgery:
The ENT will recommend surgery if a paper patch doesn't result in proper healing or the ENT determines that the tear isn't likely to heal with a patch. Tympanoplasty is the most common surgical procedure in which the surgeon grafts a tiny patch of the patient's own skin over the eardrum. The patient can go home the same day of the surgery because this surgery is done on an outpatient basis.

Prognosis:

Not Available

Expert's opinion

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Yaser Habrawi , F.R.C.S.Ed

Yaser Habrawi , F.R.C.S.Ed Consultant Ophthalmologist

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