OVERVIEW

What is a tympanic membrane perforation?

The tympanic membrane, commonly known as the eardrum, is an oval-shaped thin membrane located deep in the ear canal, separating the outer ear from the middle ear. It plays a crucial role in sound conduction during hearing.

Acute otitis media caused by inflammation, trauma, or other factors may lead to tympanic membrane perforation. Small perforations may cause no noticeable symptoms, while larger ones often result in hearing loss. Most tympanic membrane perforations can be cured with treatment.

What are the classifications of tympanic membrane perforation?

• Based on the cause, it can be classified as traumatic perforation or inflammatory perforation;
• Based on the location of the lesion, it can be classified as central perforation of the pars tensa, marginal perforation of the pars tensa, or perforation of the pars flaccida.

Clinical manifestations and treatments may vary slightly.

SYMPTOMS

What are the symptoms of a perforated eardrum?

Patients with small eardrum perforations may not experience noticeable symptoms.

Larger perforations often cause hearing loss (but not complete deafness), along with possible tinnitus, ear fullness, ear pain, ear bleeding, or dizziness.

If secondary infection occurs, symptoms like ear discharge may appear.

CAUSES

What are the causes of tympanic membrane perforation?

The main causes of tympanic membrane perforation are inflammation and trauma.

• Acute or chronic inflammation of the external or middle ear can lead to tympanic membrane inflammation and perforation;
• Trauma can directly or indirectly cause perforation, such as sharp object injuries (e.g., improper ear cleaning), foreign objects in the ear canal (e.g., insects), surgical procedures (e.g., tympanocentesis), or head trauma (e.g., temporal bone fractures);
• Sudden changes in air pressure can also perforate the eardrum, such as slapping the ear, diving, or exposure to loud explosions.

Why does the tympanic membrane become inflamed?

Depending on the source of inflammation, there are three pathways for tympanic membrane inflammation:

• From outside to inside: Bacteria or viruses invade through the external ear canal, causing inflammation;
• From inside to outside: Pathogens enter the middle ear through the nasopharynx during colds, swimming, etc., leading to acute inflammation, or recurrent chronic middle ear infections may cause tympanic membrane inflammation and perforation;
• In rare cases, inflammation may spread through the bloodstream.

DIAGNOSIS

What tests are needed for tympanic membrane perforation?

• Routine ear examinations, such as otoscope or electric otoscope;
• Various hearing tests, including speech audiometry, tuning fork test, and audiometry;
• Impedance audiometry if necessary;
• Otoscopy and nasal endoscopy;
• Imaging tests, such as CT scans of the middle ear and nasopharynx.

The doctor may select one or several tests based on the condition.

TREATMENT

Does a perforated eardrum require treatment?

A perforated eardrum can impair hearing and increase the risk of middle ear infections due to exposure to dirty water, so treatment is necessary.

Some traumatic perforations may not require immediate intervention if a doctor confirms no inflammation is present, allowing time for natural healing. However, if the perforation persists long-term, treatment is still needed.

Can a perforated eardrum be cured?

Most perforated eardrums can be successfully treated and healed.

Can a perforated eardrum recur?

Trauma-induced perforations typically do not recur unless re-injury occurs. Perforations caused by chronic inflammation may recur if inflammation redevelops after healing.

How is a perforated eardrum treated?

• Traumatic perforations: Keep the ear dry and clean, monitor for 1–3 months for spontaneous healing. Surgery may be considered if it fails to heal.
• Medication: Treating otitis media with antibiotics may allow some perforations to heal.
• Surgery: Options include tympanic membrane patching, tympanoplasty, or middle ear surgery.

Doctors typically recommend a comprehensive approach based on the condition.

Are antibiotics needed for treating a perforated eardrum?

• Uninfected traumatic perforations usually do not require antibiotics.
• Severe wounds with infection risks may need prophylactic antibiotics.
• Perforations caused by otitis media or external otitis generally require antibiotics.

Is surgery necessary for a perforated eardrum?

Surgery is unnecessary if the perforation heals spontaneously with observation or medication. Uninflamed, small traumatic perforations can typically be monitored for about three months.

Surgery is recommended if the perforation persists, recurs with pus discharge, or resists drug treatment.

What surgical options exist for a perforated eardrum?

• Tympanic membrane patching: Medicated patches aid healing without incisions.
• Tympanoplasty: Uses the patient’s tissue or grafts to repair the eardrum, possibly involving ear canal or behind-the-ear incisions.
• Middle ear surgery: Removes infected tissue and may include tympanic membrane repair, often requiring incisions.

Why might hearing remain poor after tympanoplasty?

Inflammation-induced perforations may involve damage to the ossicular chain or cholesteatoma formation. Surgery primarily targets infection control, and hearing restoration may be limited.

Should surgery still be performed if hearing may not improve?

This often applies to perforations caused by chronic otitis media. Surgery aims to eliminate infection and prevent further damage to ear or cranial structures. Hearing reconstruction depends on the severity of the condition and baseline hearing levels.

DIET & LIFESTYLE

What should patients with tympanic membrane perforation pay attention to in daily life?

Patients with tympanic membrane perforation should keep the ear canal clean, avoid swimming, and prevent water from entering the ear canal when washing hair or bathing.

Why does ear drops cause a medicinal taste in the mouth?

The tympanic membrane separates the outer ear from the middle ear. A normal tympanic membrane is sealed, preventing foreign substances like liquids from entering deeper areas such as the middle ear.

However, when the tympanic membrane is perforated, liquids entering the ear canal can flow into the middle ear. Since the middle ear is connected to the nasopharynx via the Eustachian tube, the medication can travel through the path of the ear canal → perforated tympanic membrane → middle ear → nasopharynx → oropharynx, resulting in a medicinal taste in the mouth.

PREVENTION

How to Prevent Tympanic Membrane Perforation?

• Exercise regularly, maintain a balanced routine, and prevent colds;
• Eat a healthy, well-balanced diet;
• Avoid unnecessary ear cleaning;
• Stay away from loud explosive environments, such as firecrackers;
• Avoid sudden changes in ear pressure, like diving or rapid underwater descent;
• Seek prompt medical attention for ear foreign bodies, injuries, or discharge;
• Actively treat related conditions, such as rhinitis or diabetes.