Eardrum perforation: a comprehensive guide

Eardrum perforation is a condition where there is a tear or hole in the thin membrane separating the outer and middle ear. This can lead to hearing loss, susceptibility to infections, and discomfort. Causes include trauma, infections, or pressure changes, with treatment options ranging from observation to surgical repair. Leading consultant adult & paediatric ENT surgeon Miss Victoria Alexander discusses the symptoms, common causes and treatment options.

What is an eardrum perforation and what are the most common causes?

An eardrum perforation, or a hole in the eardrum, disrupts the normal functioning of the ear. This delicate structure, akin to a thin layer resembling cling film, vibrates in response to sound waves, facilitating hearing. When a perforation occurs, sound transmission is impaired, leading to hearing loss. Additionally, the opening exposes the middle ear to external contaminants, increasing the risk of infections. Perforations commonly result from factors such as colds, which can lead to congestion and subsequent pressure imbalances.

Trauma, whether from misuse of cotton buds or exposure to loud noises, can also cause permanent damage to the eardrum. While most perforations heal within six to eight weeks, some may persist, resulting in a permanent hole. It is crucial to avoid activities that may harm the eardrum and to seek medical attention promptly if experiencing symptoms of a perforation.

What are the symptoms of an ear drum perforation?

When a hole develops in the ear, the main symptom experienced by most individuals is a decrease in hearing ability. Hearing involves the coordination of various components, including the earlobe, ear canal, eardrum, and internal structures that facilitate sound transmission to the brain. Without the intact eardrum, sound is not efficiently captured, resulting in mechanical hearing impairment. Additionally, sensitivity to weather changes may arise, particularly in cold or windy conditions, due to the lack of protective barrier provided by the eardrum.

Furthermore, the absence of this protective layer increases susceptibility to infections. Water entering the ear during activities like showering or swimming can introduce bacteria, leading to infections characterised by ear discharge. Other common symptoms include sharp ear pain, discomfort, and a sensation of air movement in the affected area. These manifestations underscore the multifaceted role of the eardrum in both auditory function and protection against external elements.

How can you be diagnosed?

In order to diagnose a whole ear drum, a professional, such as a GP will need to assess your ear drum. In some cases, individuals may undergo a routine hearing assessment at a different provider out of concern for their hearing. As part of the standard procedure, an examination of the ears is typically conducted beforehand, during which a perforation may be observed. In some cases, a picture may be taken to show the patient.

After an initial medical examination, a discussion takes place to determine the best plan of action. It's worth noting that the discovery of a perforation, or hole, may occur during a routine checkup or because the individual had a particular concern. If not for this initial examination, it's possible that the perforation might remain unnoticed.

What are the treatments for ear drum perforation?

When facing a perforated eardrum, treatment options vary. While some may opt for observation without intervention, this approach doesn't necessarily enhance hearing or prevent infections. To mitigate risks, precautions like using ear protection during bathing or showering are advised. Simple solutions such as cotton wool balls coated with petroleum jelly can suffice, although more extensive protection may be necessary for swimmers, such as over-the-counter or custom-moulded earplugs.

Occasionally, a neoprene headband may be required to secure plugs in place during water activities. Preventing infections also involves addressing itching, often alleviated by moisturising the area around the ear. If conservative measures fail or symptoms persist, surgical intervention becomes an option. Surgical repair typically involves lifting the eardrum and applying a patch or graft material to close the perforation. The choice of surgical technique and materials used depends on individual circumstances and is best discussed with a medical professional.

Are there any complications linked to the surgery?

When considering surgery for a perforated eardrum, it's essential to acknowledge potential complications, as with any surgical procedure. The primary concern is the success rate, which is notably high, particularly for those without additional risk factors such as diabetes or smoking. Success rates can reach over 90% under optimal conditions. However, if these risk factors are present, the success rate may decrease to around 70-80%.

Infections post-surgery can lead to swelling and compromise blood supply, affecting the outcome. Other less common complications include temporary taste disturbances due to nerve stretching and mild dizziness, which typically resolve within days. While hearing may improve or remain stable post-surgery, there's a slight possibility of worsening hearing. Rare risks involve facial nerve damage, albeit with minimal likelihood. Ultimately, deciding on surgery entails assessing a patient’s overall health and the likelihood of graft success.

If you would like to book a consultation with Miss Victoria Alexander, simply visit her Top Doctors profile today.