A perforated eardrum, also known as a tympanic membrane perforation, is a hole or tear in the thin membrane separating the ear canal from the middle ear.
Perforated eardrum symptoms vary considerably. Some people notice sudden hearing loss, pain, tinnitus or fluid coming from the ear. Others may have surprisingly few symptoms and only discover the perforation during an ear examination.
Many perforations heal naturally. However, a hole that remains open can leave the middle ear more exposed to water and infection and may contribute to continuing hearing problems.
This guide explains the common symptoms and causes of a perforated eardrum, how healing usually happens, when medical assessment is important and when surgical repair may be considered.
What is a perforated eardrum?
The eardrum, or tympanic membrane, is a thin layer of tissue positioned at the end of the ear canal. It vibrates when sound waves reach it and helps transfer sound into the middle ear.
A perforation means that an opening has developed in this membrane. The hole may be small or may involve a larger area of the eardrum.
The effect of a perforation depends on more than its size. Its position, the health of the middle ear, previous infections, the condition of the hearing bones and the function of the inner ear can all influence symptoms.
Many holes close naturally. Specialist treatment becomes more relevant when the perforation persists or causes continuing problems.
Common perforated eardrum symptoms
Perforated eardrum symptoms can begin suddenly, particularly when the membrane is damaged by an infection, trauma, loud noise or a rapid pressure change.
Symptoms can include:
- reduced hearing in the affected ear
- ear pain or discomfort
- ringing or buzzing sounds, known as tinnitus
- clear fluid, blood or discharge from the ear
- recurrent ear infections
- itching or an unusual sensation inside the ear
- dizziness in some cases
The amount of hearing loss does not always correspond exactly to the visible size of the hole. Other middle-ear problems can contribute to hearing difficulty and therefore need to be considered during assessment.
What causes a perforated eardrum?
There are several ways in which the tympanic membrane can become perforated.
Ear infection
Infection and pressure within the middle ear can occasionally cause the eardrum to rupture.
Trauma
A blow to the ear or an object inserted too deeply into the ear canal can damage the membrane.
Pressure change
Significant pressure differences between the middle ear and the surrounding environment can injure the eardrum.
Loud noise
A sudden intense sound or blast can occasionally cause tympanic membrane injury.
Previous ear disease
Chronic inflammation, retraction or other middle-ear conditions can affect the integrity of the eardrum.
Previous surgery
Some patients present with a recurrent or residual perforation after previous ear treatment.
How long does a perforated eardrum take to heal?
Many perforated eardrums close naturally. NHS patient guidance states that a perforated eardrum usually gets better on its own within around two months.
Healing time is not identical for every patient. The original cause, size and location of the perforation, infection, middle-ear health and previous operations can all influence what happens.
A perforation that remains open after an appropriate period of observation does not necessarily mean that something dangerous is happening, but it may justify specialist assessment if it is associated with hearing loss, repeated infections, discharge or other concerns.
NHS perforated eardrum information
NHS guidance provides information about symptoms, expected healing, keeping the ear dry and when medical advice should be sought.
Read NHS guidanceHow should you protect a perforated eardrum while it heals?
Keeping water out of the ear is one of the most important practical precautions while a perforation is healing.
Water passing through the hole can reach the middle ear and potentially contribute to infection or discharge.
Protect the ear
- keep the ear dry when washing
- follow any treatment prescribed by your clinician
- arrange assessment if symptoms persist
- protect your hearing from further trauma
Do not interfere with the ear
- avoid swimming until advised that it is safe
- do not insert cotton buds or other objects
- do not use ear drops unless they are suitable for a perforated eardrum and have been advised
- avoid forceful nose blowing while the ear heals
When should you seek medical advice?
Hearing loss and ear discharge can have several causes. An examination is important when symptoms are new, significant, persistent or worsening.
Sudden or rapidly worsening hearing loss should not simply be assumed to be caused by a perforation.
NHS guidance recommends urgent medical assessment for sudden hearing loss, hearing that has deteriorated over days or weeks, or hearing loss associated with symptoms such as earache or discharge.
Other concerning symptoms, such as severe dizziness, facial weakness, significant injury, severe pain or feeling acutely unwell, also warrant appropriate medical assessment.
What happens if a perforated eardrum does not heal?
A perforation that remains open may be described as persistent or chronic.
Not every persistent perforation requires an operation. The decision depends on the symptoms, hearing, condition of the middle ear, infection history and the priorities of the patient.
Surgical repair is usually called myringoplasty. A broader reconstructive procedure may be referred to as tympanoplasty when additional eardrum or middle-ear treatment is required.
The potential aims of treatment may include closing the hole, creating a more stable ear, reducing problems related to water or recurrent infection and, in suitable cases, addressing associated conductive hearing loss.
How is a persistent eardrum perforation assessed?
Specialist assessment is designed to establish why the perforation has persisted and whether anything else within the ear is contributing to symptoms.
Clinical history
Previous infection, injury, ear surgery, hearing symptoms, discharge and the duration of the perforation are reviewed.
Ear examination
The size and position of the perforation and the condition of the surrounding eardrum and middle ear are assessed.
Hearing assessment
Audiological testing can help establish whether hearing loss is conductive, sensorineural or mixed.
Treatment discussion
Continued observation, protection of the ear and surgical repair can then be discussed according to the individual findings.
Frequently asked questions about perforated eardrums
Can a perforated eardrum heal itself?
Yes. Many perforations heal naturally. NHS guidance states that a perforated eardrum usually gets better by itself within around two months.
Can a perforated eardrum cause hearing loss?
Yes. A perforation can interfere with the transmission of sound through the middle ear. The amount and type of hearing loss depend on the individual ear and whether other structures are affected.
Can I get my ear wet with a perforated eardrum?
It is generally advisable to keep the ear dry while the perforation heals. Water entering the middle ear can contribute to infection or discharge.
Can I fly with a perforated eardrum?
NHS guidance states that flying is generally safe with an existing perforated eardrum. The advice is different after surgical repair: following myringoplasty, you should not fly until your surgeon confirms that it is safe.
When is myringoplasty considered?
Myringoplasty may be considered when a perforation has not healed naturally and there is a clinical reason to close it, such as recurrent problems, water sensitivity or associated hearing difficulty.
Independent patient resources
For general NHS information about perforated eardrums, symptoms, treatment and when to seek medical help:
NHS — Perforated eardrumThis article provides general information and does not replace individual medical assessment, diagnosis or treatment. Seek appropriate medical advice if you have new, significant or worsening ear or hearing symptoms.
Arrange a specialist ear assessment
If a perforation has not healed, you have continuing hearing problems or recurrent discharge, a specialist assessment can help establish what is happening and which treatment options may be appropriate.
This page is for general information only and does not replace individual medical assessment, diagnosis or treatment. Seek prompt medical advice for sudden hearing loss or other urgent symptoms.
