Perforated eardrums are holes in the tympanic membrane that most commonly occur as a consequence of an ear infection or trauma to the ear.
While the ear might be very painful just prior to the eardrum rupturing, the actual perforation is generally painless, and in fact it is usually associated with a relief of the pain. The characteristic sign of a perforated eardrum is discharge of fluid from the affected ear.
Among children, eardrum perforations are usually associated with middle ear infections which are very common in this age group. Infected fluid can build up very quickly in the middle ear and cause the eardrum to rupture. In such cases the subsequent hole in the eardrum will usually heal very quickly, once the infection resolves – most frequently with antibiotics.
This type of perforation rarely causes any long-term problems. However in children who have repeated middle ear infections and repeated perforations, scarring of the eardrum can occur. Grommets - small ventilation tubes placed in the eardrum – are often the treatment of choice in these children to help reduce the frequency and severity of the middle ear infections. Grommets work by allowing the fluid in the middle ear to safely discharge into the ear canal, bypassing the blocked Eustachian tube.
Perforated eardrums caused by trauma occur from a rapid compression of the air that is in the ear canal, pushing it against the eardrum causing it to rupture. In Australia it is frequently seen in water skiing or surfing accidents and in children who have received a blow to the side of the head.
Traumatic perforations of the eardrum are more risky in terms of failing to heal properly, particularly when they have occurred in water where there is a danger some contaminated water might have entered the middle ear.
Perforations that fail to heal may require surgery.
In all cases of eardrum perforation it is important the ear is kept dry until the drum has healed completely. This means wearing waterproof earplugs when swimming and even sometimes when showering to avoid fluid entering the middle ear through the hole in the drum, and potentially affecting hearing.
Reviewed by Dr Linda Calabresi, GP, Artarmon, NSW