Tympanic Membrane Perforation

The ear drum is a small, 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. There may be one or more holes in 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.  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.

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!” Perforated ear drums can be diagnosed by a thorough examination of your ears by your physician and by having a hearing test (audiogram).

A few things can be done to try to prevent tympanic membrane perforations.  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.  Additionally, 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.

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. 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.