A hole in the eardrum, also known as tympanic membrane perforation, is a rupture or tear in the thin tissue that separates the ear canal from the middle ear. This condition can result from various causes, including infections, trauma, sudden pressure changes, or loud noises. Tympanic membrane perforation can lead to hearing loss, recurring ear infections, and other complications if left untreated. Understanding the causes, symptoms, diagnosis, and treatment options is crucial for managing this condition effectively.

Causes

The eardrum can be perforated due to several reasons:

Infections: Chronic ear infections can lead to the accumulation of fluid or pus in the middle ear, increasing pressure on the eardrum and eventually causing it to rupture.
Trauma: Physical injury to the ear, such as a severe blow to the head, inserting objects into the ear canal, or even excessive cleaning with cotton swabs, can damage the eardrum.
Barotrauma: Rapid changes in air or water pressure, which often occur during flying, scuba diving, or exposure to explosions, can lead to a perforated eardrum.
Loud Noises: Acoustic trauma from sudden, extremely loud noises like explosions or gunshots can rupture the eardrum.

Symptoms

The symptoms of a perforated eardrum can vary in severity and may include:

Sudden sharp pain in the ear, which may subside quickly
Hearing loss in the affected ear
Tinnitus, a ringing or buzzing noise in the ear
Discharge from the ear, which may be clear, bloody, or purulent
Vertigo or dizziness
Nausea or vomiting, especially if the perforation affects the inner ear

Diagnosis

Diagnosis of tympanic membrane perforation typically involves a thorough medical history and a physical examination by an ENT specialist. The most common diagnostic tool is the otoscope, which allows the doctor to look directly at the eardrum. In some cases, additional tests such as audiometry (hearing tests) may be conducted to assess the extent of hearing loss.

Treatment

The treatment for a perforated eardrum depends on the size of the perforation, the underlying cause, and the presence of symptoms or complications. Options include:

Observation: Many small perforations heal on their own within weeks to months. During this time, it’s crucial to keep the ear dry and avoid water entry to prevent infections.
Medication: If an infection is present, antibiotics may be prescribed. Pain relievers can also help manage discomfort.
Patch: For larger perforations that don’t heal on their own, an ENT specialist might apply a chemical patch to stimulate healing or perform a minor procedure to place a paper or gel patch over the hole.
Surgery: Persistent perforations that do not heal with conservative treatment may require surgical intervention. The most common procedure is tympanoplasty, where the surgeon uses a piece of the patient’s own tissue to repair the hole.

Complications

If left untreated, a perforated eardrum can lead to chronic ear infections, middle ear cysts (cholesteatoma), and permanent hearing loss. Ensuring proper diagnosis and treatment is crucial to prevent these complications.

Prevention

Preventive measures against tympanic membrane perforation include:

Avoiding inserting objects into the ear, including cotton swabs
Treating ear infections promptly to prevent progression to a more severe stage
Using ear protection in environments with loud noises
Taking precautions to equalize ear pressure during altitude changes, such as swallowing or yawning during airplane takeoffs and landings

Conclusion

A perforated eardrum can be a painful and potentially serious condition that may lead to complications if not properly treated. Understanding the causes, symptoms, and treatment options is essential for those affected. With prompt medical attention, most individuals with a tympanic membrane perforation can expect a full recovery and a return to normal ear function. It’s important to follow the advice of healthcare professionals, particularly ENT specialists, to manage this condition effectively and prevent future occurrences.

When should you see an ENT specialist in Singapore?

Please consult an ENT specialist if you are suffering from any ear, nose, or throat symptoms. It is also advisable to visit an ENT doctor if you experience persistent mouth breathing due to a chronic blocked nose or encounter snoring issues.

Dr Ker Liang sees adults and children for general ENT conditions and provides comprehensive management in a broad range of Ear, Nose, and Throat, as well as Head and Neck conditions. In particular, she has a special interest in treating throat and voice conditions, including persistent sore throat, voice issues, snoring, and Obstructive Sleep Apnoea (OSA).

Medical Teaching

Assistant Professor Ker Liang has a passion for teaching and is an Assistant Professor with NUS Yong Loo Lin School of Medicine (YLLSOM). As the NUS-NUH Otolaryngology Department Undergraduate Medical Director, Dr Ker Liang supervises the training of medical students from YLLSOM, NUS. She is actively involved
in the training of postgraduate junior doctors and residents in the Head and Neck Surgery department. She was conferred with an Undergraduate Teaching Award by the National University Health System in 2016 for her outstanding efforts as an Otolaryngology educator.

Medical Teaching

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Hole in the eardrum (Tympanic membrane perforation)

Causes

Symptoms

Diagnosis

Treatment

Complications

Prevention

Conclusion

When should you see an ENT specialist in Singapore?

Medical Teaching

Medical Teaching

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