Perforated eardrum

Also called Ruptured eardrum, Burst eardrum

A hole in the eardrum, usually from infection or injury. Most heal by themselves; the rule while it does is keep the ear dry.

What it is

A hole or tear in the eardrum, the membrane separating the outer and middle ear.

The commonest cause is a middle ear infection bursting through under pressure, which typically relieves severe earache suddenly and produces discharge. See otitis media. Others are injury, including cotton buds and other objects pushed into the ear, a blow to the ear, a blast, and pressure change during flying or diving.

Most perforations heal by themselves within six to eight weeks. Hearing loss during that time is usually mild and temporary.

The critical rule while it is healing is to **keep water out of the ear**. Water carries bacteria into the middle ear and causes infection, which delays healing and can cause lasting damage.

A perforation that does not heal can be repaired surgically, and persistent perforations need review because of the risk of cholesteatoma, an abnormal skin growth in the middle ear that erodes bone and requires surgery.

**Never put anything in the ear canal to clean it.** Cotton buds cause perforations, push wax deeper, and are the reason a substantial number of these happen. Nothing smaller than an elbow, as the old advice goes.

Signs you might notice

Sudden earache that then eases abruptly, often with discharge.

Discharge from the ear: watery, bloody or containing pus.

Hearing loss on that side, usually partial.

Ringing in the ear. See tinnitus.

Sometimes dizziness or vertigo.

Same-day assessment: severe dizziness or vertigo; facial weakness; severe pain; discharge that continues for more than a few days; high fever; or swelling, redness or tenderness of the bone behind the ear, which may be mastoiditis.

Also assess: perforation after a head injury or blast, or with significant hearing loss.

Do not use ear drops unless a clinician has confirmed it is safe with a perforation; some are harmful to the inner ear.

How it can affect day-to-day life

The practical burden is water avoidance for weeks: showering, hair washing and swimming all need planning. Cotton wool coated in petroleum jelly, or a properly fitted swim mould, works better than improvised solutions.

Swimming is generally out until it has healed and been checked.

Flying is usually best avoided until healed, and diving should not be resumed without an ear check.

For children, keeping water out during hair washing is the main practical challenge, and it is worth doing properly because recurrent infection is what turns a simple perforation into a chronic ear problem.

People frequently continue using cotton buds after a perforation caused by one, and the advice needs stating explicitly rather than implied.

Persistent discharge with hearing loss over months should never be accepted as normal; it needs ENT assessment.

Supporting someone well

Keep the ear completely dry. Cotton wool with petroleum jelly for showering; no swimming or submersion until cleared.

Do not put anything in the ear: no cotton buds, no drops unless prescribed for a perforation, no irrigation, no ear candles.

Take simple pain relief as needed.

Avoid flying and diving until healed and checked.

Get a follow-up check at six to eight weeks to confirm it has healed; this is often skipped.

Get ongoing discharge, dizziness, facial weakness or worsening pain assessed the same day.

Ask for ENT referral if it has not healed in around three months, or for recurrent perforations.

Have hearing tested if loss persists after healing.

Where to get help

A GP practice for diagnosis and follow-up.

Same-day assessment for dizziness, facial weakness, severe pain or signs of mastoiditis.

Ear, nose and throat services for perforations that do not heal.

ENT UK and RNID publish patient information on ear problems and hearing.