Tympanic Membrane Perforation

What is a tympanic membrane perforation?

A tympanic membrane perforation, also known as a ruptured eardrum, is a hole in the eardrum.


What causes it?

There can be many causes for a ruptured eardrum. Trauma from exposure of the ear to a loud blast, or a slap to the ear with a cupped hand, and rapid changes in pressure can result in a hole in the eardrum.  If a sharp object, like a Q-tip, is put too far into the ear canal it can cause a rupture. Middle ear infections can lead to ruptures. The hole can also be a result of a weakened area of the eardrum from a cholesteatoma, or a skin cyst of the ear. Chronic buildup of pressure in the ear, also called Eustachian tube dysfunction, can also lead to a hole. Eardrums that have had ear tubes can leave behind a perforation. 


Why is it a concern?

A ruptured eardrum can cause some hearing loss. It can also make a person more susceptible to ear drainage and ear infections as it allows a path for water and bacteria to enter the middle ear, especially when exposed to water during swimming or bathing.  Sometimes, the size of the hole in the eardrum is fixed, but sometimes it can grow with time and lead to a larger amount of hearing loss. Eardrum holes are also at risk for causing skin cysts (cholesteatomas), at the edge of the hole.


How do we evaluate it?

An evaluation begins with an examination by an Ear, Nose and Throat doctor (Otolaryngologist). The doctor will likely use a microscope to further evaluate the rupture or hole. A hearing test is useful to assess the level of hearing loss.


How is it treated?

Some small ruptures of the eardrum may heal on their own with time.  Larger holes may require surgery to close, especially if they are causing significant hearing loss or recurrent ear drainage and infections. Surgery entails grafting tissue from around the ear to patch the hole.  In some cases, perforations can be treated with observation, with antibiotics on an as needed basis for infection.

Example of a tympanic membrane perforation, as seen through the ear canal.

Example of a tympanic membrane perforation after surgical repair. Here, a graft (dotted lines) has been placed under the eardrum to patch the hole.  In this case, an incision in the ear canal was used to access the ear drum.