CEI Medical Group
California Ear Institute
Global Hearing
California Face & Laser Institute icon

Perforation (Hole) in the Tympatic Membrane (Ear Drum) Causes and Treatment



The ear drum is a small, (about a third of an inch in diameter), delicate, oval membrane that separates the middle ear from the outer ear. The ear drum is thus a barrier which helps in preventing infections from spreading from the outer ear to the middle ear. The ear drum is also involved in hearing. When sound waves strike and vibrate the ear drum, these waves are carried through to the middle ear, then the inner ear, and in turn to the brain where they are processed so that you can “hear” these sounds as speech, music and other auditory sensations.


A perforation is a tear or other opening in the delicate tympanic membrane. Sometimes this is referred to as a “burst” ear drum or a “ruptured” ear drum. Perforations can be single or their may be more than one opening of the ear drum. The opening may be in various locations. These factors influence the ear drums capacity to heal and also affect the hearing loss to varying degrees. (Photo or diagram-perforation of the tympanic membrane).

It is easy to understand how any abnormal condition of the ear drum ( tympanic membrane) can increase the risk of perforations which can result in ear infections and hearing loss.


There can be many causes of perforated ear drums. Perforated ear drums are frequently the result of infection, either as a child or as an adult. Various types of ear trauma can also result in a hole in the ear drum and possible hearing loss.. An example of trauma of this sort would be striking the ear in a fall while wake boarding . Injury to the ear drum can also occur when such objects as cotton swabs, bobby pins or other objects are used in an attempt to remove wax from the ear. A very loud noise, such as an explosion, can also cause a perforation or other injury to the ear. Less common causes of perforations include a fractured skull or hot spark or slag entering the ear while welding.

Changes in air pressure (called barotrauma) occasionally can cause ear drum perforation. This may occur when flying with a severe cold, and usually occurs on descent.


The usual symptoms of a perforation are either discharge from the ear, ear ache (otalgia), or a change in hearing. Bleeding or pus from the ear may indicate the presence of a perforation. A more subtle symptom may be that the ear just “doesn’t feel right.!”

In severe trauma to the ear, as seen in skull fractures, there is often damage to the three bones of hearing in the middle in. In these cases the loss of hearing may be severe and is often associated with ringing of the ears (tinnitus).


Perforated ear drums can be diagnosed by a thorough examination of your ears by your physician and by having a hearing test (audiogram).This exam may be carried out by a pediatrician, or family practitioner. A small instrument called an otoscope may be used or a more detailed exam may be more accomplished by use of an operating microscope by specially trained otologists as is the practice at the California Ear Institute.


Ear infection symptoms should not be ignored. All suspected ear infections should be assessed and treated as promptly as possible, and any prescribed antibiotics should be taken until completion.

  • Never try to remove an object which is lodged in your ear canal.
  • Do not use objects such as cotton swabs or paper clips in your ears in an attempt to clean them.
  • Do your best to avoid contact with persons who have colds of a flu-like illness.

Make certain that children are current with their immunizations as recommended by their pediatrician. In particular, the Prevnar vaccination (23-valent pneumococcal polysaccharide) is estimated to reduce the number of ear infections by 10 to 20 percent in children with recurrent ear infections.


Many perforations of the tympanic membrane heal on their own. This is particularly true of smaller perforations located towards the center of the ear drum.

Some perforations may require a surgical procedure called a tympanoplasty. It is a form of microsurgery (operating using a surgical microscope) where tissue is removed from another part of the body, usually around the ear, and attached (grafted) to the area of the ear drum that is perforated. In some cases, the tympanoplasty procedure may also be done with other surgeries including repair of the three small bones of hearing in the middle ear, if they are involved . The surgery is usually performed on an outpatient basis.

Usually, tympanoplasty surgeries are quite successful. In most cases, the perforation is closed permanently and the hearing is improved. As with any surgery, the choice of an experienced physician is essential. Due to patient and professional referrals, the physicians of the California Ear Institute continue to have vast experience in the diagnosis and treatment of tympanic membrane perforations. Many of the current techniques for eardrum repair were originated at the California Ear Institute.


If you suspect you have a perforated tympanic membrane, your best chance for a complete recovery is to seek a comprehensive medical examination and specialty care from an Otologist, who is an otolaryngologist (ENT) who has undergone two additional years of training and specializes in hearing only. With appropriate medical treatment and therapy, individuals with perforated tympanic membranes can fully function in a hearing world.

Click here to make an appointment with the California Ear Institute to consult with one of our board certified Otologists regarding your ear-related condition.




California Ear Institute