Perforated Eardrum

Perforated ear drums are a common occurrence from a range of different causes. Fortunately in most cases the body will heal the hole if given sufficient time and if infection can be avoided. In some cases the hole is caused by a more serious cause that requires more urgent treatment.

How does a perforation occur?

• A severe middle ear infection, often in childhood
• Self cleaning the ear canal with a cotton bud
• Sporting injuries, such as a blow to the ear
• Work related injuries, for example, a burn from a welder’s spark
• Gardening where a sharp branch or leaf (eg from a Yucca) enters the ear
• Some fungal infections of the external ear canal
• Insertion of a grommet in the ear drum, or other operations of the middle ear

What are the dangers with a perforation?

Having a hole in your eardrum is not necessarily dangerous depending on the cause. It is important to keep water out of the ear as it can enter the middle ear through the hole in the ear drum. This can cause recurrent ear infections which can damage your hearing permanently in some cases. Ear perforations always cause some hearing loss unless very small. Once they close hearing may return to normal.

How is it diagnosed?

Your GP can often visualise a perforation in their office with an otoscope. Often the ear canal and ear drum needs to be cleaned by an ENT specialist with microscopic suction tubes before the perforation can be adequately assessed. Once this is done a hearing test is usually necessary to determine the degree of hearing loss. In some cases tympanometry may be necessary to detect a very small hole. Tympanometry involves a pressure test by a small soft probe placed in the ear canal. If suspicious features are seen on examination occasionally a CT scan to further examine the middle ear and mastoid is necessary.

What is the treatment?

Once a serious cause has been ruled out that does not need surgery urgently, often the initial management is a period of observation. If water can be kept out of the ear and infections prevented, the body will heal the majority of perforations without needing surgery. Surgery should be considered in the following situations:

• If the perforation is associated with a serious cause such as a tumour or cholesteatoma (cyst)
• If the ear is discharging frequently
• If infections continue to occur despite keeping the ear dry
• If the hearing loss is a significant problem

You can read more about what is involved in surgically repairing a hole in the eardrum here – Myringoplasty (repair of a hole in the eardrum)