A perforated eardrum, also called a ruptured eardrum or tympanic membrane perforation, means there is a hole or tear in the tympanic membrane, the tissue that separates the outer ear canal from the middle ear. What does a perforated eardrum feel like? Ruptured eardrum symptoms include a sharp pop, sudden eardrum pain, muffled hearing, ringing, or fluid coming from the ear.
The eardrum (tympanic membrane) is a thin tissue that helps transmit sound waves as nerve impulses to the inner ear and protects the middle ear from water, bacteria and debris. You may have a perforated eardrum if ear symptoms start suddenly after an ear infection, ear injury, a sudden loud noise (an ‘acoustic trauma’), or a sudden change in air pressure.
When the eardrum ruptures, hearing can drop, drainage may appear, and the middle ear becomes more vulnerable to ear infections, including bacterial infections. Most ruptured eardrums heal on their own, but some need ENT care or surgical repair.
The main types of eardrum perforation are acute or chronic. They are also described by the cause, size, and presence of a middle ear infection. In simple terms, an acute perforation is a new rupture, often caused by ear infections or trauma, whereas a chronic perforation is one that does not close and may continue to cause middle ear discharge or hearing loss.Â
A small fresh rupture after an ear infection behaves differently from a long-standing perforation with repeated drainage and ear infections. ENTs also consider whether the injury is traumatic, infectious, dry or discharging, and whether it is small or large. A large perforated eardrum is more likely to cause greater hearing loss and less likely to heal cleanly without intervention. In severe cases, surgery to repair the eardrum may be needed.
The most common perforated eardrum symptoms are sudden ear pain, hearing loss, ringing and fluid leaking. A ruptured eardrum means the eardrum moves abnormally, and sound waves cannot pass properly to the inner ear. A person may notice that they cannot hear soft sounds, hearing that is blocked or muffled, a buzzing or ringing noise, or a wet sensation. Perforated eardrum discharge may be clear, pus-like or bloodstained, and perforated eardrum bleeding can happen after trauma or a sudden tear.
Perforated eardrum signs can also include dizziness or vertigo if the inner ear is affected. Some patients experience spinning and may even experience nausea or vomiting when balance is affected. Severe or persistent vertigo raises concern for a more severe injury, especially after barotrauma or a severe head injury.
The most common cause of an eardrum rupture is a middle ear infection. The eustachian tube connects the middle ear to the back of the nose, and when it is blocked by a stuffy nose or congestion, pressure changes in the middle ear can cause a ruptured eardrum, perforated from within.Â
Other causes include trauma like a slap; barotrauma when inadequate pressure equalisation between the middle ear space and the external environment is different, like when flying or diving;Â a cotton swab or foreign objects pushed into the ear canal; or a blast injury or a severe head injury.
You should seek medical care and see an ENT specialist if your ear pain is severe, if hearing loss is sudden, or if symptoms do not improve over the next few weeks. A suspected ruptured eardrum warrants examination if there is ongoing discharge, hearing loss, repeated middle ear infection or dizziness.
An ENT review is also sensible if there is a known long-standing hole in the eardrum, especially when water regularly triggers ear infections. Chronic perforations can lead to recurrent middle ear infection, and in some patients, the ear specialists also need to rule out complications such as cholesteatoma or damage to the small middle ear hearing bones. Untreated ear infections can lead to permanent hearing loss.
Diagnosis is usually made by examining the eardrum and assessing whether hearing has been affected. In the clinic, our ENT specialists use instruments such as an otoscope or an operating microscope to examine the outer and middle ears and assess the size and position of the tympanic membrane rupture. In many cases, the ruptured eardrum is visible straight away.
A proper assessment of a ruptured eardrum often includes hearing tests such as an audiology exam and, sometimes, tympanometry or tuning fork testing. If there is active drainage, the fluid may be sent for laboratory testing to identify the ear infection. If symptoms suggest more than a simple rupture, such as a persistent middle ear infection, ossicular damage, or a possible cholesteatoma, further imaging may occasionally be needed.
Most ruptured eardrums that are small will close on their own. Most ruptured eardrums also heal without surgery, provided the ear is kept dry while the thin tissue heals. When the eardrum heals, hearing usually concurrently improves. This is why initial treatment for a ruptured eardrum perforated by infection or trauma is often conservative.Â
Over-the-counter medicine may relieve discomfort for a fresh rupture, while antibiotic ear drops or oral antibiotics are used if a middle ear infection is present. Ruptured eardrums heal best when the middle ear stays dry and free from ear infections. Many holes close within a few weeks, though some take up to two months, especially if they are large, repeatedly infected or exposed to water.Â
Patients often ask about the healing time for a perforated eardrum. The most honest answer is that it depends on the cause, size and whether it stays dry. Water exposure, repeated nose-blowing, further trauma, and ongoing ear infections can all slow healing. Keep the ear dry during washing, use cotton balls or cotton wool covered in petroleum jelly to protect the ear canal.Â
Swimming with a perforated eardrum should be avoided until the eardrum heals fully. Blow your nose gently. Avoid inserting small objects into the canal. When flying, pressure-equalising earplugs can help manage changes in air pressure. Chewing gum during flights may also help equalise air pressure.
For selected cases, the next step may be an office-based eardrum patch rather than full surgery.
Perforated eardrum surgery is called tympanoplasty to repair the eardrum. Surgery is only considered when a ruptured eardrum does not heal, keeps getting infected, or causes troublesome hearing loss. The goal is to repair the eardrum, close the hole in the eardrum, improve the middle ear’s resistance to ear infections, and improve hearing by restoring the tympanic membrane’s ability to vibrate and transmit sound waves properly.
During tympanoplasty, the surgeon repairs the ruptured eardrum using a graft, often taken from thin tissue or cartilage. The operation may be done through the canal or through a small incision, depending on the perforation and the technique used. If the middle ear ossicles are damaged, they may sometimes need attention in the same sitting.
Myringoplasty is the repair of the eardrum to help prevent future middle-ear infections and, sometimes, improve hearing loss. Myringoplasty usually refers to repairing the eardrum itself, whereas a tympanoplasty may also involve reconstruction within the middle ear. For patients, the important point is that surgery is tailored to the size, location and behaviour of the perforation.
Peforated Eardrum Specialist
If you have a perforated or ruptured eardrum and notice that your hearing is getting worse or you are experiencing discharge from your ear, arrange an assessment with Dr Barrie Tan. Early evaluation can help determine whether treatment is needed and reduce the risk of ongoing problems.
Tympanoplasty for a ruptured eardrum is usually safe, but recovery still requires care, and the result is not guaranteed in every case. Most patients go home the same day or after a short stay. Mild bloody discharge, middle-ear pressure, crackling, and temporarily reduced hearing are common early on.
Recovery from the operation itself often takes around 10 days to 2 weeks, but it may take several weeks or even a few months to fully settle. The middle ear and eardrum must be kept dry, and patients are usually advised to avoid nose-blowing, forceful changes in air pressure, and air travel until their surgeon says it is safe.
Possible risks include failure of the graft to seal the hole, recurrent perforation, middle ear infection, tinnitus, dizziness, altered taste and, rarely, worsening hearing loss.
If your ear is blocked, hurts, or is leaking fluid, don’t try to guess what’s wrong, especially if you think your eardrum might be torn or has a hole in it. If you have persistent symptoms, a known, non-healing tear, repeated ear infections, or changes affecting daily life, an ENT specialist can clarify the cause and the best treatment for your ruptured eardrum.
At Barrie Tan ENT Head & Neck Surgery, patients receive a thorough evaluation and a treatment plan tailored to their middle-ear condition and daily needs. To discuss your symptoms and whether you may benefit from observation, patching or tympanoplasty, contact the clinic to arrange a consultation with Dr Barrie Tan.
MBBS, MRCS (Edinburgh), MMed (Otorhinolaryngology), FAMS
Dr Barrie Tan is an ENT specialist at Gleneagles Hospital, Singapore, with more than 20 years of clinical and surgical experience. He previously served as Head of ENT and Director of the Centre for Hearing and Ear Implants at Singapore General Hospital. The information provided is not intended as medical advice. More about our medical experts.
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