Tympanic Membrane Damage / Injury / Bursting Under Water
Summer means vacation and fun in the sun, and nothing says "vacation" quite like a splash in the pool. While laughing and playing games by the pool can be harmless fun, some seemingly innocent pranks can have painful and dangerous consequences, especially when they involve the ears. One of the most overlooked yet serious risks is a perforated or injured eardrum. My patient came with ear pain that start after the trauma when joking in pool. After long-term swimming in the pool, simple external otitis can be considered in the first place, but ear trauma also changes the differential diagnosis firstly.
What is a Perforated Eardrum?
Your eardrum, or tympanic membrane, is a thin membrane-like tissue that separates your outer ear from your middle ear. It plays a vital role in hearing by transmitting sound vibrations and also acts as a barrier that protects the inner ear from infection and injury. In other words, it functions as both a hearing aid and a barrier. The eardrum can be damaged or perforated due to pressure changes, trauma, or infections. A perforated eardrum occurs when this delicate membrane ruptures. Symptoms of a perforated eardrum:
- Sudden loss of hearing
- Sharp pain or discomfort in the ear
- Fluid or blood discharge from the ear
- Ringing (tinnitus)
- A feeling of fullness or pressure in the ear
- Dizziness or balance problems
How Can Pool Pranks Cause an Eardrum Injury?
Pool pranks may seem like jokes—splashing someone unexpectedly, dunking a friend in the water, or yelling loudly into someone's ear—but under the right (or wrong) circumstances, these actions can cause serious ear trauma.
Here are some common scenarios:
Sudden Water Pressure from Rapid Immersion
Pushing someone into the water, especially unprepared, can cause a sudden change in water pressure against the eardrum. If the pressure is too intense or uneven between the ears, it can rupture the eardrum.
Slapping the Ear While Entering the Water
Accidentally slapping someone on the side of the head or ear, whether as a prank or a misjudged splash, can cause a hydraulic slap, sending a shockwave directly to the eardrum.
Shouting Near the Ear
Shouting or whistling directly into someone's ear at close range can create a loud sound wave that can damage the delicate inner structures of the ear, including the tympanic membrane. High-energy sound waves, such as bomb explosions, typically cause eardrum perforation. A human yell may only cause temporary damage to the inner ear.
Why Are Children at Higher Risk?
Children often exhibit more energetic and impulsive behavior when playing in the pool. The eustachian tubes (which help regulate ear pressure) are narrower and more easily blocked, increasing the risk of pressure-related ear damage. Furthermore, children may not always notice or ignore the early signs of ear trauma.
How to Provide First Aid for a Suspected Eardrum Perforation
If someone experiences ear pain or hearing loss after a pool accident, it's important to act quickly:
Avoid exposure to water: Keep the ear dry to prevent infection.
Do not insert anything into the ear, including cotton swabs.
Seek medical attention: An ENT specialist can examine the injury and recommend treatment.
Pain relief: Over-the-counter pain relievers can help temporarily reduce discomfort.
In most cases, small perforations heal on their own within a few weeks. Severe or permanent tears may require antibiotics, special ear drops, or even surgical repair (tympanoplasty).
Preventive Tips for Safe Pool Play
- Educate children and teens about the risks of rough pool play.
- Avoid underwater wrestling, immersion, or sudden thrusts.
- If you are prone to ear problems, wear ear protection, such as earplugs.
- Always equalize pressure (such as by yawning or swallowing) before and after swimming or diving.
- Watch for signs of ear pain, discomfort, or discharge after pool activities.
Eardrum Rupture in The Pool
The eardrum is located between the middle ear and the outer ear and has a certain degree of stretching during external pressure changes. In case of sudden pressure changes, tears in the eardrum can be seen. In particular, during the dive and dive, the external pressure increases during deep dive, and when the pressure in the middle ear drops below the external pressure, a pressure trauma to the eardrum occurs.In the photo on the above, there is a bursting of the eardrum as a result of sudden pressure change while joking under water in the pool. Bloody areas in the outer ear canal and in the eardrum and traumatic perforation on the eardrum are seen. Many antibiotic resistant microorganisms can survive in pool waters (due to chemical disinfection rather than complete replacement of pool water and "stable water"). In addition, there are different side effects of chlorine in the pools which are disinfected with color.
Paper Patching For Tympanic Membrane Perforation
After 1 day after the trauma, the dead tissue around the hole in the eardrum was cleaned, and the antiseptic-impregnated paper patch was placed on the eardrum and a 2-month follow-up was planned. After the traumatic injury of tympanic mebrane, contact with the ear should be avoided until the hole in the membrane is closed.In case the hole in the eardrum does not close during follow-up, an eardrum surgery is planned.
When the Eardrum Perforates Underwater, the Middle Ear Ossicles and Inner Ear Can Also Be Affected!
The eardrum can rupture underwater due to trauma or pressure changes. In this case, the rapid movement of external water into the middle ear can damage the ear ossicles, and the ingress of pressurized water can also damage the inner ear. The sudden ingress of cold water into the middle ear can also cause severe dizziness, and patients can become dangerously disoriented and swim deeper.
If the Eardrum Perforates in a Pool, a Serious Otitis Media Can Also Develop!
Pool water is generally disinfected with iodine. Single-celled microorganisms and bacteria can survive in pool water and are resistant to antimicrobial agents. The rapid ingress of this water into the middle ear can trigger long-term middle ear infections that are resistant to antibiotics, leading to the death of the epithelial tissue surrounding the perforation, potentially leaving the perforation permanently open.
Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul
Private Office:
Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
Appointment Phone: +90 212 561 00 52
Appointment Phone: +90 212 561 00 52
Fax: +90 212 542 74 47
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