What Causes a Ruptured Eardrum and How to Treat It

Ruptured eardrum symptoms

While you might think that an eardrum rupture is a dramatic event you’d notice right away, that’s not always true, Le Nobel says. Some people can be “totally unaware,” at least at first, he says.

When signs of a ruptured eardrum show up, they can include:

Hearing loss. This happens because your eardrum plays a crucial role in hearing — vibrating in response to sound waves. Those vibrations are transferred to the bones of the middle ear, starting a chain of events that get sounds to your brain.

Some people with an eardrum perforation will say, “I can’t hear at all, compared with my other ear,” while others notice more subtle changes, Le Nobel says. People might say their hearing is “muffled,” LaCour says.

Ear pain. Many people notice an immediate “ouch” when they rupture their eardrum, LaCour says. By the time they see a doctor, he says, there’s often no pain. Ear pain can become chronic, though, if the perforated eardrum is infected, Le Nobel says.

Leaking fluid. Depending on the cause, the ruptured eardrum might bleed or leak clear, whitish or yellow fluid. If blood coming from your ear is your only symptom, though, “more likely than not, it’s not a hole,” LaCour says. Usually, he says, it’s from scratching the skin in the ear canal.

Ringing or buzzing in the ears. Tinnitus, a condition that causes phantom ringing or buzzing in the ears, may worsen if you have a hole in your eardrum, Le Nobel says.

Spinning sensations (vertigo). The vertigo might also cause nausea. These symptoms can happen because damage to the eardrum affects the inner ear’s vestibular system, which controls balance.

Le Nobel describes what his own ruptured eardrum felt and looked like: “At first, I didn't know what was going on. Then I realized it hurt, and I had difficulty hearing. And later that day, I had some blood coming out of the ear.” He says he also could “feel air in a part of the ear where it shouldn't be.… It just didn't feel right.”

You might wonder if you can see your own ruptured eardrum. With the naked eye, you can’t, Le Nobel and LaCour say. But both say they’ve seen patients who bought ear scoping devices online that allowed them to see deeper into their ear canal and take pictures.

Even then, LaCour says, the untrained eye might not be able to tell if the eardrum is ruptured or not. A spot of blood, he says, might look like a hole.

It's also not a great idea, he says, to stick anything into your own ear.

Diagnosing a ruptured eardrum

If you think you might have a perforated eardrum, see a doctor, both LaCour and Le Nobel urge.

The doctor will ask about your symptoms and then look in your ear with a lighted scope. Ideally, LaCour says, the doctor will also use a tool called a tympanometer. This device can measure the volume of the ear canal and how the eardrum responds to changes in air pressure. If the eardrum doesn’t move and the canal is larger than usual, that confirms a hole, he says.

Your doctor may also refer you to an audiologist for a full exam of your outer, middle and inner ear to see if you have any hearing loss.

Ruptured eardrum treatment

You may need no treatment at all, because most eardrum holes close within a few weeks. One small study found that about half closed within four weeks, 81 percent closed within three months and 97 percent closed at some point, without medical intervention.

Smaller holes tend to heal fastest, LaCour says. Infection can slow healing, Le Nobel says.

If your doctor sees signs of infection in the ear, you’ll probably get antibiotic ear drops, both doctors say. Le Nobel says he often prescribes oral antibiotics as well.

While you’re waiting to see if the hole heals, you should: ·     

• Keep the ear dry. Your audiologist can make a set of silicone earplugs that are custom molded to you. They’ll keep your ears dry and can help prevent more eardrum ruptures.
• Resist cleaning your ear. That could slow healing.
• Avoid blowing your nose. The pressure could further damage your eardrum.

Whether any other treatment is considered can depend not only on how long the tear lasts but also on how bad any hearing loss is and whether water restrictions are a problem for you — for example, if you play water sports, Le Nobel says.

In general, he says, he suggests waiting about a year to see if the hole closes. LaCour says he might recommend a procedure within a few months if it looks like the hole isn’t making progress toward healing.

If you decide on treatment, it might include: ·     

• A temporary patch, often made of paper, that can act as “scaffolding” for the healing tissue, LaCour says. You can get that procedure in a doctor’s office.
• A surgery called a tympanoplasty, to use tissue from your own body or, sometimes, a pig, to close the hole. That requires a visit to an operating room, but you usually go home the same day.

If you have hearing loss from a perforation and don’t want surgery, or aren’t a candidate for anesthesia, hearing aids might be a reasonable option, Le Nobel says.