Eardrum (Tympanic Membrane) Perforation

What is an eardrum (tympanic membrane) perforation?

Tympanic membrane perforation, also known as a perforated eardrum, is a hole in the thin membrane that separates the ear canal from the middle ear.

What causes a tympanic membrane perforation?

A tympanic membrane perforation can have many causes. In people who have had ear tubes (tympanostomy tubes), a perforation can result when the eardrum does not close up after the tube comes out. While this is rare, it is seen from time to time. In other cases, frequent ear infections can cause a tympanic membrane perforation. During a middle ear infection (otitis media), pressure from pus under the tympanic membrane sometimes produces a small hole in the tympanic membrane. This is the body’s natural way of draining the pus and getting it out of the ear. Finally, traumatic injuries, like cotton swab (Q-Tip) use can cause a tympanic membrane perforation.

What are the symptoms of a tympanic membrane perforation?

A tympanic membrane perforation can cause problems, depending on the size of the hole and where the hole is in the eardrum.

Tympanic membrane perforations can cause a conductive hearing loss (where the sound does not reach the inner ear). In general, the larger the hole, the larger the hearing loss. A hearing test (audiogram) can easily check how much hearing loss there is.

Tympanic membrane perforations can cause ear infections. The middle ear (the space beneath the tympanic membrane) is not supposed to get wet from the outside world. If water gets into the middle ear, a middle ear infection (otitis media) can happen. The exception is that very small tympanic membrane perforations generally do not cause ear infections because not much water will travel through them. In these cases, very tiny tympanic membrane perforations act similar to permanent ear tubes.

How is a tympanic membrane perforation treated?

A new tympanic membrane perforation will usually heal itself. When the hole is formed, regardless of the reason, the body will try to heal it. However, sometimes, the perforation does not heal on its own. If the size of a tympanic membrane perforation has not gotten any smaller in about two months, it will probably not heal on its own.

In most, but not all, cases we recommend fixing tympanic membrane perforations. We particularly recommend this when there is a hearing loss or when the hole is causing infections. Fixing the hole can often fix these problems. An otologist can help you make this decision.

Repairing a tympanic membrane perforation involves a minor surgery. This is generally a routine, outpatient procedure that takes a couple of hours. Our surgeons make a cut inside the ear canal or behind the ear. The eardrum is then lifted up. A material is then used to patch the hole. Several materials can be used, depending on the exact situation. These include a small piece of cartilage, fascia (muscle lining), or synthetic materials. The eardrum is folded back down and some dissolvable packing is placed in the ear canal. You will usually go home a couple of hours after you wake up.

Surgeons at Columbia Otolaryngology are pioneering a new technique for repairing tympanic membrane perforations. In some situations, this can allow repairing the hole entirely through the ear canal, without making any visible incisions. This might result in faster healing and less pain. For more information, read about endoscopic ear surgery at Columbia.

Medicine, including ear drops and pills you take by mouth, will not fix a chronic (present for more than a couple of months) tympanic membrane perforation. If the perforation is recent, then sometimes antibiotic eardrops will be used to treat ear infections that occur along with it.

What do I do until my tympanic membrane perforation is fixed?

It is important to keep the ear dry. In all but the smallest perforations, water can travel through and cause a middle ear infection (otitis media). One simple way to keep the ear dry is to place a cotton ball soaked in petroleum ointment (e.g., Vaseline) on the outside of the ear canal during showering. Avoiding swimming is also recommended, although in some cases watertight earplugs can help.