Why Is The Eardrum Perforated? - Different Causes and Photos

Causes of Eardrum Holes

Perforation of the eardrum

The eardrum may be perforated for different reasons. Traumatic eardrum perforations (except for hot burn injuries) usually recover spontaneously without any problem if the ear is protected from water contact; perforation of the eardrum due to recurrent middle ear infections is usually permanent.

The eardrum is a thin membrane that separates the middle ear from the outer ear canal and is a very important component of the human sensory organ. Perforation of the eardrum occurs as a result of rupture or perforation of this membrane. When the eardrum is punctured, hearing is reduced and sometimes there is a discharge from the ear. A tearing and ringing sound can be felt in the ears, but usually no pain occurs. Perforation of the eardrum may occur suddenly after a sensation similar to thunder. In some cases, you may experience sharp pain in your ears and the pain may disappear suddenly. Eardrum rupture is a common problem and there are many different treatment methods available today.

Symptoms of eardrum rupture

  • Sudden and sharp ear pain in the ear
  • Bloody, clear or haze-like discharge from the ear
  • Ringing or humming in the ear
  • The onset of hearing loss
  • Dizziness

The drawbacks of the eardrum being a hole

Perforation or damage of the eardrum is manifested by symptoms such as pain, ringing, dizziness and hearing loss. Failure to diagnose the damaged membrane may lead to the persistence of these symptoms and result in severe hearing loss. Although the tympanic membrane heals spontaneously, the disturbing symptoms it creates have a negative effect on the person's daily life. The biggest harm is the risk of irreversible hearing loss.

What happens if the eardrum hole is left untreated?

Closure of the hole in the eardrum occurs spontaneously in many people. If there is no serious infection or hearing loss, the eardrum can close without surgery. However, the risk of infection increases, and most importantly, permanent hearing loss may occur in people who do not consult a doctor after the onset of symptoms. For this reason, signs of tear in the eardrum should refer the patient to a doctor. The doctor will recommend a painkiller, antibiotic drip or surgery, as appropriate.

Sometimes patients may not notice the hole in the eardrum!

Perforation of the eardrum; Hearing loss, humming and ringing in the ears, occasional bruising, and dizziness may be among the symptoms expressed by the patients. Contrary to expectations, pain is not one of the symptoms.

Patients do not care about this situation, they may have more serious problems if they do not take years of discharge into account and protect their ears. Especially if there is no infection in the eardrum perforation caused by a sudden impact on the ear, a great deal of self-healing can be seen, but the support of an ENT specialist should be obtained to ensure the correct and rapid healing process. After hearing your complaints, the ENT specialist will check the condition of your ear by performing a hearing test.

Causes of eardrum perforation

The causes of tympanic membrane perforation can be summarized as follows:

Traumatic Causes

. Direct traumas
. Head trauma (visible with skull fracture)
. Traumas during explosion
. During insertion of cotton swab or other foreign object into the ear
. Pressure trauma (barotrauma - during air travel or diving)
. High sound trauma (acoustic trauma)

The photograph on the side shows the eardrum and the outer ear canal of a patient with blood swabs and hearing loss during ear cleaning with a cotton swab.

Bleeding traumatic areas in the outer ear canal and tympanic membrane are seen due to trauma of the cotton swab.

The photograph on the left side shows traumatic perforation of the eardrum and bloody discharge of the external auditory canal in the eardrum of the patient who complained of hearing loss and blood coming from the ear after trauma to his ear while joking in the pool.

Infectious Causes

In recurrent middle ear infections and the associated eardrum perforations, the hole in the eardrum may become permanent. In this case, a tympanic membrane surgery and the removal of inflammatory tissues in the middle ear may be required.

Eustachian Tube Disorders

In patients with chronic eustachian tube problems, because the air circulation in the middle ear is less than normal, the eardrum may become thin or perforated or collapse pockets may occur. In the early period of eustachian tube dysfunction, structural changes in the membrane can be prevented by ventilation tubes that can be attached to the eardrum.

What is the treatment of tympanic membrane perforation?

Most perforation of the tympanic membrane heals itself within a few weeks, while some of the perforation may last for months. In cases that do not close spontaneously within 8 weeks, surgery may be required.

The perforation of the membrane is often patched with medication and paper closure. The discharge can usually be stopped with medications. Patching may be required several times to completely close the puncture. However, surgical intervention is needed in cases that do not close after these applications.

There are different surgical methods for perforation of the tympanic membrane. However, in all methods applied, the membrane is covered with a tissue to improve perforation. This intervention, referred to as tympanoplasty or mrieingoplasty, can be successful in closing the perforation and correcting hearing.

In cases with severe hearing loss, operation of the middle ear ossicles or removal of inflammation surrounding and around the middle ear may be necessary.

To treat perforation in the membrane; It is also useful to prevent infections that may occur due to water leakage to the middle ear during bathing and swimming, and to provide rapid healing and decrease in ringing.

If the tympanic membrane is surgically closed, what should the patient do immediately after surgery?

  • Patients are generally discharged on the day after surgery.
  • Patients should protect their ears from the water postoperatively and use drops containing antibiotics and cortisone to prevent infections.
  • It is necessary not to travel in the first month and to be protected from impacts and influenza infections.
  • Raising the bed within one week after the operation reduces blood pressure and edema in the middle ear and behind the ear.
  • The mouth should not be closed during sneezing.
  • It is better to eat healthy and drink plenty of water to prevent constipation.
  • Constipation can affect the ears negatively due to straining.
  • Activities such as diving, swimming and water skiing should not be performed within 12 weeks of surgery.
  • Tampers in the outer ear canal should be replaced by a doctor. Buffers should not be removed without consulting a doctor.

What should be done to prevent eardrum rupture?

  • Foreign substances should not be inserted into the ears to prevent tearing of the eardrum
  • Ear cleaning cotton should also be used with caution
  • High pressure changes should be avoided and precautions should be taken
  • Ears should not be exposed to very loud sound
  • Heavy sports exercises should be avoided or controlled
  • Hot water and acidic water should be prevented from entering into the ear
  • If the ear is hit or painful, the family doctor should be consulted.
Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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