The eardrum and its role
The eardrum is a thin but strong membrane separating the outer ear canal from the middle ear. It transmits sound vibrations to the hearing bones and at the same time protects the middle ear from water and microbes. A hole (perforation) in the drum disturbs both of these functions.
Why does the eardrum perforate?
There are two main causes: infection and trauma. During acute middle ear infection, accumulating pus can burst through the drum; in chronic otitis media the hole becomes permanent. Traumatic perforations result from a blow or slap to the ear, sudden pressure changes (blast, diving) and objects such as cotton swabs touching the drum.
Symptoms
A sharp pain at the moment of perforation followed by relief is typical; bloody or purulent discharge, reduced hearing, ringing and sometimes brief dizziness may accompany it. With permanent holes, the main complaints are hearing loss and recurrent discharge triggered by water contact.
Can the hole close on its own?
A large proportion of fresh, small traumatic perforations close spontaneously within a few weeks to months, provided the ear is kept dry. During this period, avoid getting water into the ear, do not pick the ear, and do not use drops except on your physician's advice. Holes that have not closed after three to six months are usually permanent, and surgical repair comes into consideration.
Eardrum repair surgery (tympanoplasty / myringoplasty)
In surgery, the hole is patched with the patient's own tissue — most often cartilage membrane (perichondrium), cartilage or muscle fascia. In many cases the operation can now be performed endoscopically through the ear canal, without external incisions. Damaged hearing bones are repaired in the same session. The operation usually involves one night in hospital; during recovery the ear is kept dry for a few weeks and advice about flying, straining and nose-blowing should be followed. Success rates are high; the aims are complete cessation of discharge, an ear resistant to water contact, and improved hearing where possible. See also Chronic Otitis Media.
This article is for general information purposes only; please consult your physician for diagnosis and treatment.