Ruptured Ear Drum Causes

A ruptured eardrum is also called a perforated eardrum by medical professionals. To truly understand what causes this condition you must understand the function of the eardrum (also called the tympanic membrane) and some of the physiology and anatomy of the inner ear.

The eardrum is a thin membrane that separates the ear canal from the middle ear. The auditory tube (also called the Eustachian tube) is a small tube that runs from the middle ear to the nose. The auditory tube functions to clear mucus from the inner ear, ventilate the middle ear and to equalize atmospheric pressure within the middle ear. It does this, in part, by opening and closing at strategic times to allow ventilation of the middle ear.

When the Eustachian tube fails to function properly (a condition called Eustachian tube dysfunction), pressure can build inside of the middle ear, causing the eardrum to bulge or even rupture (this means that the thin membrane actually breaks or gets a hole in it).

Many conditions can cause Eustachian tube dysfunction, including excess mucus (congestion) from a cold or allergies, which may clog the auditory tube or prevent it from opening properly. Enlarged structures such as the adenoids may also crowd or block the auditory tube. The following conditions can also contribute to a ruptured eardrum:

• Ear infections
• Rapid changes in ambient pressure (called barotrauma—often occurs while scuba diving, taking off or landing in an airplane)
• Extremely loud noises such as a gunshot or explosion
• Foreign objects like pencils or bobby pins inserted into the ear which can puncture the eardrum
• Trauma (if the ear is struck, or in the case of a skull fracture, for example)

These conditions are usually accompanied by an underlying cause of auditory tube dysfunction. Children may be at higher risk of rupturing their eardrum than adults since the Eustachian tube in children is smaller and does not function as efficiently as it does in adults. That being said, a ruptured eardrum can occur in individuals of all ages.

Some people suffer from chronic Eustachian tube dysfunction, and this condition can actually weaken the eardrum over time. For example, someone who has chronic auditory tube dysfunction from untreated allergies may be more likely to rupture their eardrum while taking off in an airplane than someone who has a normally functioning auditory tube.

Symptoms

Ruptured eardrums can be painful at the time of rupture, and this severe pain is sometimes followed by a feeling of relief if the rupture is due to high pressure. Symptoms of a ruptured eardrum can include:

• Fluid draining from the ear (may be bloody)
• Ear pain
• Sudden hearing loss
• Tinnitus (ear ringing)
• Dizziness or vertigo

Diagnosis

Diagnosing a ruptured eardrum is not usually difficult. Your healthcare provider will ask you about your symptoms and the circumstances surrounding the rupture. Then the healthcare provider will examine your eardrum with an instrument called an otoscope. If the eardrum has ruptured, damage to the tympanic membrane, such as a hole, a scab, or a scar may be visible. 

Treatment

The treatment of a ruptured eardrum is not usually complicated. In most cases, the eardrum will heal on its own within 2 months. You should see a healthcare provider if you suspect an ear infection, or if persistent ear drainage or hearing loss is involved.

A healthcare provider may prescribe antibiotics if an ear infection caused the rupture or if an active infection is suspected. Over-the-counter pain relievers like acetaminophen are often helpful for pain.

In some rare cases, it may be necessary for a healthcare provider to surgically repair the perforation (hole). This usually involves placing a patch over the damaged part of the ear and can sometimes even be done in the healthcare provider's office.

This procedure is called a myringoplasty or tympanoplasty. You should keep water out of your ear until the perforation has healed to avoid infection. Your healthcare provider will give you more detailed instruction about how to care for your ear after this procedure.

If your ruptured ear drum was caused by underlying Eustachian tube dysfunction, this should also be treated. You may need to be tested for allergies or have sinus problems treated. These issues are usually best addressed by a healthcare provider who specializes in disorders of the ear, nose, and throat (an otolaryngologist or ENT).