Eardrum Problems
Evaluation and treatment of eardrum perforation and other structural eardrum conditions
What is eardrum problems?
The eardrum is a thin membrane stretched across the end of the ear canal. It seals the middle ear off from the outside world and converts air movement into movement of the three small bones behind it. A hole anywhere in it does two things: it lets less of that movement through, and it opens a sterile space to whatever gets into the canal.
Most holes come from a middle ear infection that built up pressure until the drum gave way, or from an injury such as a slap across the ear, a cotton bud pushed too far or a blast. A ventilation tube placed in childhood can leave a small one behind when it works its way out.
Size and position both matter. A small hole away from the edge often seals itself within a few weeks, and the drum regains its full thickness over months. A large one, or one that reaches the bony rim, has no scaffold to heal across and tends to stay open.
What you might notice
- Discharge from the ear
- Difficulty following conversation
- Ear pain
- Ringing in the ears
How it is diagnosed
The doctor looks into the canal with a microscope or an endoscope, which shows the edges of the hole, how much of the drum is involved and whether the middle ear lining behind it is dry or inflamed. A photograph is often taken so the size can be compared at the next visit.
An audiogram measures how much has been lost and, more importantly, whether the loss matches the size of the hole. A loss that is larger than the hole should explain suggests the chain of bones behind it is also involved, and that changes what is offered.
A tympanogram confirms the middle ear is open to the outside. Where there has been long-standing infection, a scan of the temporal bone is added to check the mastoid air cells behind the ear.
Recovery
A perforation being watched asks only that the ear is kept completely dry. That means a cotton ball smeared with petroleum jelly in the canal for showers, no swimming and no diving until the drum is confirmed closed.
After a repair, the ear is packed and there is a feeling of fullness and muffled sound for several weeks while the packing dissolves and the graft takes. Hearing is not judged until about three months, and it is normal for it to seem worse before it is better.
Nose blowing is restricted for the first few weeks because the pressure travels straight up to the graft. Most people are back at desk work within a week and avoid flying, swimming and heavy lifting for six.
If it is left untreated
A small hole left alone frequently closes on its own, and watching it for six to eight weeks is a reasonable plan when the ear is dry and the loss is minor.
One that stays open is a standing route for water and bacteria into the middle ear, and each episode of infection scars the lining a little more. Over years that scarring stiffens the chain of bones, and the loss that follows is no longer fixed by closing the drum. Where the edge of the drum is involved, skin from the canal can grow inwards into the middle ear and erode bone, which is a different and more serious problem than the hole itself. That is the reason a perforation at the rim is reviewed instead of simply watched.
Questions about eardrum problems
Will the hole close on its own?
Often, yes. A small perforation in the central part of the drum, in an ear that is otherwise dry, closes by itself in a majority of cases within six to eight weeks, and the drum regains its thickness over the following months. Your doctor will usually watch it over that period with the ear kept strictly dry and repeat the examination. Holes that are large, that sit at the bony rim, or that have been present for months have no edge to heal across and are unlikely to close without a graft.
Can I swim or shower with a perforation?
Showering is fine provided you keep water out of the canal, which usually means a cotton ball smeared with petroleum jelly, replaced each time. Swimming is not advised while the drum is open, and diving and jumping in are specifically avoided because they drive water through under pressure. Water reaching the middle ear through a hole is the commonest way a quiet perforation turns into an infection, and each infection makes the eventual repair harder.
Will my hearing come back after a repair?
Closing the drum reliably stops the ear discharging and protects it, and hearing usually improves, though how much depends on why it was reduced. Where the loss was caused by the hole itself, most of it is recovered. Where the small bones behind the drum have also been damaged, a myringoplasty that only patches the drum will not address that, and a tympanoplasty that rebuilds the chain is what your surgeon would discuss. The audiogram taken before surgery is what tells them which situation you are in, and hearing is not formally retested until about three months afterwards.
Other ENT treatments
Management of recurrent or persistent tonsil problems, including medical treatment and surgery when indicated
Day CareTreatment for enlarged or chronically infected adenoids that may affect breathing, sleep or ear health
Day CareTalk to a care coordinator about eardrum problems
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one