A ruptured eardrum is a perforation in the tympanic membrane that separates the outer and middle ear. A ruptured eardrum can result in complications, such as ear infections and possible permanent hearing loss, if left untreated. While severe cases may require surgery, a ruptured eardrum will typically heal on its own in about eight weeks.
The tympanic membrane is a layer of very thin, skin-like tissue that serves to sense and convert sound waves, or vibrations, into nerve impulses. The eardrum transmits the vibrations to the small bones, called ossicles, in the middle ear that your brain translates into sound. The eardrum also protects the middle and inner ear from infections and foreign objects.
Many people never notice symptoms of a perforated eardrum. Others will notice a general discomfort in their ear or hear or feel air passing through their ear when blowing their nose. This is because blowing your nose will cause air to rise up to fill the space in the inner ear that causes the membrane to expand outward. However, air will be able to escape if there is a hole in the membrane.
Sometimes the sound of escaping air can be loud enough for others standing close by to hear. Infections from bacteria, viruses and fungi are the most common causes of a perforated eardrum. Conversely, a perforated eardrum can also result in periodic ear infections. Other symptoms of a ruptured tympanic membrane may include a sudden pain in the ear, drainage from the ear, reduced hearing, a buzzing or ringing in your ear, a spinning sensation or vertigo.
1. Ear Pain
While discomfort may not always be present, perforations of the tympanic membrane usually results in pain if the cause of the rupture is infectious or from the result of trauma. Typically, the presence of pain or the lack thereof is dependent on the size and the underlying cause of the rupture.
Mild to severe pain may increase for a prolonged period of time before abruptly decreasing. The pain may be dull or sharp, continual or be intermittent. These variables have many controlling factors, including the size of the perforation and the location of the hole on the surface of the membrane.
Infections are usually the primary cause of a ruptured ear drum. Fluid buildup from a viral infection behind the tympanic membrane can lead to a subsequent bacterial infection. The infection can cause pressure to build up behind the inner ear and in the Eustachian tube. This in turn exerts pressure on the tympanic membrane, causing it to stretch. If the buildup of pressure becomes severe enough it can cause the membrane to rupture.
Unless the perforation was caused by sudden trauma, there is usually no pain in the absence of infection. Acoustic trauma in the form a sudden strong vibration, like an extremely loud noise, strong wind or impact from water, can cause the membrane to suddenly rupture, resulting in a sharp pain.
2. Drainage from the Ear
Draining from the ear typically occurs only after the eardrum has ruptured, resulting in a watery puss-like discharge from the ear that may be white, yellow or bloody in color. Usually the ear will begin to drain once the pain goes away. This is because the fluid that was built up behind the tympanic membrane, and causing the pressure and pain, is released through the tear in the membrane. The discharge, if present, will usually last between one and five days. However, sometimes there will be discharge from the ear even if the eardrum has not ruptured. The only way to know for sure is to check with your healthcare provider, especially if you are experiencing hearing loss.
3. Hearing Loss
The eardrum is connected to the bones in the middle ear. When sound waves hit the eardrum it causes the ossicles to vibrate and send signals to the nerves that the brain then interprets as sound. A perforation in the eardrum restricts the ossicles from moving normally, resulting in a reduction in the signals that reach the brain.
Hearing loss may be partial or complete in the affected eardrum. Usually, the larger the tear in membrane the more hearing will be affected, as less signals reach the brain. If the perforation is very large the eardrum may not be able to transmit any signals at all, resulting in complete hearing loss. This can also lead to a ringing sound in the ear.
4. Ringing In Your Ear
Ringing in your ear is referred to as “tinnitus” and is usually the result of damage to the tiny nerve filaments in the inner ear. These filaments, called cilia, interpret the vibrations and send the signals on to your brain. Sometimes the cilia become damaged as the result of a ruptured ear drum and send out incorrect signals.
If the perforation of the membrane was the result of a sudden traumatic event, such as a loud blast, the loss of hearing and ringing in the ear can be severe. In most cases the hearing will usually return, at least partially, within a few days as the ringing subsides. In extreme cases, it can sometimes take a month or longer for tinnitus to stop completely.
5. Spinning Sensation
Balance and equilibrium are controlled by the organs in the middle and inner ear called the “vestibular apparatus.” These organs contain three semicircular canals with each canal containing three crystals, or “stones.” These three canals exist at right angles to each other and represent all three-dimensional planes in space. The canals are connected to a group of sensory cells that sends signals to the brain.
When the head shifts position the stones move across the cilia and the cerebellum interprets the movements to determine the position of the crystals, relative to gravity, providing the body with its balance. A ruptured ear drum can cause the crystals to move independently from the position of the head, sending the wrong signals to the brain, causing a spinning sensation know as “vertigo.”
6. Vertigo
Vertigo is defined as a false sensation of motion or feeling off balance. As vertigo is typically caused by a problem with the inner ear, balance can be dramatically affected by a ruptured ear drum. While vertigo in itself is harmless, other symptoms such as loss of hearing, headache, dizziness and double vision may be present if vertigo is the result of a ruptured eardrum. Vertigo can also lead to nausea, a feeling of a severe upset stomach accompanied by the urge to vomit. However, like tinnitus, vertigo is not always a symptom or the result of a ruptured ear drum.
You should contact your healthcare provider if vertigo is severe or persistent.
