Section 19. Ear, Nose, and Throat Disorders

Chapter 220. Middle and Inner Ear Disorders

Topics: Introduction | Perforation of the Eardrum | Barotrauma | Infectious Myringitis | Acute Otitis Media | Serous Otitis Media | Chronic Otitis Media | Mastoiditis | Meniere's Disease | Vestibular Neuronitis | Temporal Bone Fracture | Auditory Nerve Tumors | Tinnitus

Perforation of the Eardrum

A perforation is a hole in the eardrum.

A middle ear infection (otitis media) is the most common cause of eardrum perforation. The eardrum can also be perforated by a sudden change in pressure--either an increase, such as that caused by an explosion, a slap, or diving underwater; or a decrease, such as occurs while flying in an airplane. Another cause is burns from heat or chemicals. The eardrum may also be perforated (punctured) by objects placed in the ear, such as a cotton-tipped swab, or by objects entering the ear accidentally, such as a low-hanging twig or a thrown pencil. An object that penetrates the eardrum can dislocate or fracture the chain of small bones (ossicles) that connect the eardrum to the inner ear. Pieces of the broken ossicles or the object itself may even penetrate the inner ear. A blocked eustachian tube may lead to the perforation because of severe imbalance of pressure (barotrauma).

Symptoms and Diagnosis

Perforation of the eardrum causes sudden severe pain, sometimes followed by bleeding from the ear, hearing loss, and noise in the ear (tinnitus (see Section 19, Chapter 220)). The hearing loss is more severe if the chain of ossicles has been disrupted or the inner ear has been injured. Injury to the inner ear may also cause vertigo (a whirling sensation). Pus may begin to drain from the ear in 24 to 48 hours, particularly if water or other foreign material enters the middle ear. A doctor diagnoses eardrum perforation by looking in the ear with a special instrument called an otoscope.

Treatment

The ear is kept dry. Ear drops containing an antibiotic may be used if the ear becomes infected. Usually, the eardrum heals without further treatment, but if it does not heal within 2 months, surgery to repair the eardrum (tympanoplasty) may be needed. If a perforation is not repaired, the person may develop a smoldering infection--chronic otitis media--in the middle ear.

A persistent conductive hearing loss (see Section 19, Chapter 218) following perforation of the eardrum suggests a disruption or fixation of the ossicles, which may be repaired surgically. A sensorineural hearing loss or vertigo that persists for more than a few hours after the injury suggests that something has injured or penetrated the inner ear.