Disease/Disorder Name:
Perforation of the Eardrum
ICD-9 Description:
Perforation, Central, Tympanic membrane
Description:
Perforation of the eardrum is a rupture of the tympanic membrane. Also called a
"Burst Eardrum".
A healthy ear drum - note the pink, healthy look
A burst ear drum -
notice the raw, inflamed look which also denotes
an infection
Causes of a burst eardrum
External Causes of a Burst Eardrum
An external cause for a burst eardrum is a head
trauma such as a blow to the ear or an object
penetrating the ear canal and penetrating the
eardrum. An immediate trip to the emergency room
is mandatory. Usually an X-Ray or MRI scan will
be performed to view the possible middle/inner
ear damage. Remediation can range from immediate
general surgery to just a cleaning and
application of antibiotics.
If the middle or inner ear appear not to be
seriously affected, the ER nurse or doctor will
clean the ear carefully give you an antibiotic shot
and antibiotic ear drops, then prescribe antibiotic
tablets for a 10 day regimen. In severe cases, you
may go into immediate surgery or in less severe
cases be referred to an ENT specialist (Ear,
nose, Throat specialist). If it is a really
serious case, a head and neck surgeon or ENT
surgeon will be called in to repair the damage
as much as possible.
With an explosive event, the loss of
hearing can be accompanied by ringing in the ear
(tinnitus) and severe vertigo. If blood is not
leaking from the ear, the hearing
should partially return. Depending on the severity, the ringing
may diminish
in from a few days to a few months.
Side effects of a perforated eardrum (burst
eardrum) will definitely be excruciating pain.
You will probably also suffer from
vertigo and/or tinnitus.
Usually, the larger the perforation, the greater the
loss of hearing. The location of the hole
(perforation) in the eardrum also effects the degree
of hearing loss. If severe trauma (e.g. skull
fracture) disrupts the bones in the middle ear which
transmit sound or causes injury to the inner ear
structures, the eventual loss of hearing may be quite severe.
If a burst eardrum fails to heal (3-4 weeks) you may need
either a tympanoplasty or myringoplasty to
repair the eardrum. (discussed further in this
document).
Internal Causes
of a Burst Eardrum - Otitis Media
Perforated eardrums from internal causes are
usually from
middle ear infections (otitis Media) (viral or bacterial).
Detritus from the infection in the inner ear
causes pressure to build in the middle ear
cavity and if not relieved, the eardrum will
burst outward.
Symptoms of a burst eardrum from internal causes
Sharp pain as the eardrum bursts, then initial
pain relief.
Pus discharge from the ear, and usually very
smelly
Bleeding
from the ear
Hearing loss
Tinnitus
Vertigo
Throbbing pain as the middle and inner ear is
subject to direct contact with the air
Home treatments for a burst eardrum
OK. Your eardrum just burst . If you have had a
middle ear infection
that pushed out the eardrum, then the throbbing pain
has been greatly diminished. Wipe off the smelly
pus with a damp cloth, and sit quietly with a warm
compress on that side of the head. Gently lay with
the affected ear down so that drainage can occur.
To alleviate some of
the pain,
any of the following can be taken:
Ibuprofin(Tylenol™) etc. (No more than 4 a day
every 4 hours for 7 days - see Note 1)
Note 1: For adults, no more than 1500
milligrams per day; for pre-teens over 12 and under 16 years
old, no more than 750 milligrams per day. WARNING: Continued high doses of ibuprofen (in
adults, over 2000 milligrams per day for over 30 days) have been shown to increase
the likelihood of intestinal bleeding and
liver failure.
FDA COMMENTS
If you can tolerate a
few days of associated vertigo, dizziness, and dull pain from
the open ear drum, you may not need to see a doctor
as the hole will in all likelihood heal on its own.
This occurs in the majority of burst eardrums from
middle ear infections. It will depend on
the size of the hole, and the extent of the inner
ear infection. If you still don't feel good after
three days, it probably means the middle ear
infection is still present and needs to be treated.
Antibiotics are usually prescribed, sometimes initially by injection, then a regimen orally
three times a day for at least 7 days.
Note: In the past, antibiotics such as penicillin, erythrocyn, or erythromycin were prescribed.
However, in the last few decades, many in the general population have become immune to the effects
of these antibiotics, and stronger ones are often prescribed. (The cause of immunity is often blamed on
the same antibiotics fed to the food supply (chickens and beef)) before they are brought to market.
If a hole in the eardrum does not close naturally
within two weeks, it should be closed by other
methods ASAP to prevent the possibility of water
entering the ear while showering, bathing, or
swimming (which could reinitiate an ear infection or
exacerbate an already present ear infection) (See
Myringoplasy and Tympanoplasty below).
The Healing Process of a Burst Eardrum
As the eardrum heals and the opening closes, you will probably notice a marked
improvement in your hearing over the prior days.
Any vertigo, dizziness, tinnitus and pain should
slowly abate. A healthy healed eardrum will also prevent the development of a
cholesteatoma (skin cyst in the middle ear), which
can cause chronic infection and destruction of the
ossicles.
The long term effects of a burst eardrum
and subsequent operations on the ear will be a
function of the size of the hole that was repaired,
and how many times the eardrum has to be worked on
before the hole is completely healed. With any
tissue that heals, there is scar tissue residue;
with any operation on body tissue, there is also
scar tissue residue. Scar tissue is the natural
end-result of a successfully healed eardrum.
The eardrum's purpose is to vibrate. the
buildup of scar tissue inhibits that vibration
function; the greater the scar tissue, the less the
eardrum will vibrate, affecting the ability to hear.
As a rule of thumb, a hole in the eardrum that heals
on its own within a few weeks or months will have
minimal effect on hearing. However, continual
operations on the ear drum will build up scar tissue
and could cause severe hearing loss due to the
subsequent scar tissue making the tympanic
membrane inflexible.
A myringoplasty should only affect
hearing loss to a maximum of 5%. Then again if the
surgeon does an excellent job with a tympanoplasty
and the hole is relatively small, hearing loss will
be negligible. If there is more serious additional
damage to the ossicles in the middle ear requiring
an operation, the results could affect hearing quite
negatively.
Summary
In 80% of
cases, the eardrum will heal on its own with
perhaps the assistance of antibiotics.
Myringoplasties (Tympanoplasties) are routine
operations performed at either Childrens'
Hospitals or General hospitals.
