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Perforated eardrum: what are the symptoms of a tympanic perforation?

By Cristiano Antonino On Jun 20, 2022

A tympanic perforation is the tearing of the tympanic membrane, following complications of acute or recurrent otitis media or trauma of various kinds

In the event of a tympanic perforation – or perforated eardrum – it is important to consult an ENT specialist as soon as possible.

What are the symptoms of a perforated eardrum and how is it treated?

The eardrum has two main tasks:

– it allows us to hear. When sound waves hit it, the eardrum vibrates, initiating the process of translating sound waves into nerve impulses;

– it protects the middle ear from water, bacteria and foreign substances.

If the eardrum ruptures, major problems can occur, especially if it fails to heal spontaneously after three to six months.

A perforated eardrum can cause

– hearing loss. Usually, the hearing loss is temporary and only lasts until the eardrum rupture heals;

– middle ear infection (otitis media). A perforated eardrum can allow bacteria to enter the ear more easily, increasing the likelihood of infection;

– development of a middle ear cholesteatoma. This involves the accumulation of epidermal cells (skin cells) in the middle ear. The presence of epidermal debris in the middle ear provides a favourable environment for the proliferation of bacteria and fungi resulting in the development of recurrent infections that can eventually damage the middle ear structures.

Tympanic perforation: symptoms

Signs and symptoms of a perforated eardrum may include:

recurrent otalgia: pain in the ear especially when water enters;
otorrhea: discharge of more or less dense, sometimes foul-smelling secretions from the ear;
otorrhagia: discharge of traces of blood from the ear;
progressive hearing loss;
tinnitus;
dizziness and subsequent nausea and vomiting (rarely).

Perforated eardrum: what are the causes

Causes of perforated eardrum include:

middle ear infection (otitis media). An infection of the middle ear often causes fluid to accumulate inside it. The pressure of these fluids can cause the eardrum to rupture;
barotrauma. Barotrauma is the stress exerted on the eardrum when the air pressure in the middle ear and the air pressure in the environment are unbalanced. If the pressure difference exceeds a certain limit, the eardrum can perforate. Barotrauma is often caused by sudden pressure changes on the ear (e.g. slap on the ear, dive into the water) Other events that can cause sudden pressure changes – and possibly a rupture of the eardrum – include scuba diving if compensatory mechanisms are ineffective or direct trauma to the ear, such as the impact of a car air bag;
acoustic trauma. A close explosion can cause rupture of the eardrum;
foreign bodies in the ear. Some objects, such as Q-tips or a hairpin, can cause a perforation of the eardrum;
severe head trauma. Severe head trauma, involving a fracture of the skull base, can cause dislocation or damage to middle and inner ear structures, including the eardrum.

What to do when a perforated eardrum is suspected?

The first thing to do when a perforated eardrum is suspected is to undergo a specialist ENT examination, in which the specialist, after a careful anamnesis, will define the diagnosis and treatment.

The diagnosis of tympanic perforation requires an oto(micro)scopia and a tonal audiometric examination, which make it possible to assess the characteristics of the perforation (e.g. location and size of the perforation, presence of keratinous debris in the middle ear (cholesteatoma), state of the ossicular chain) and the hearing capacity.

The examination involves the use of an endoscope or microscope to assess the external auditory canal, tympanic membrane and middle ear.

Once the clinical evaluation of the tympanic perforation has been completed, a diagnostic completion using a Computed Tomography (CT) scan of the petrous spools is necessary to assess any middle ear changes caused by the perforation.

What to do when a tympanic perforation is detected?

The first advice in the case of a tympanic perforation is not to wet the ear to avoid the risk of overinfection.

If the perforation is small and post-traumatic, it often heals spontaneously.

The treatment of inveterate tympanic perforation may require surgery for myringoplasty or tympanoplasty.

It is necessary when episodes of over-infection, characterised by otorrhea (discharge of secretions from the ear), become recurrent and unresponsive to antibiotic therapy, or when the tympanic perforation has favoured the development of a cholesteatoma (accumulation of skin) in the middle ear.

Depending on the characteristics of the perforation (site and size), the state of the ossicular chain and the presence or absence of a cholesteatoma, the operation may require reconstruction of the eardrum alone (myringoplasty) or removal of the cholesteatoma and reconstruction of the ossicular chain (tympanoplasty).

The decision as to which type of surgery is necessary will be made by the ENT specialist on the basis of the clinical and radiological findings, and the patient will be informed about the possible expected results of the reconstruction of the eardrum and the possible benefits on hearing recovery.