Eardrum perforation

[Dorothey Allen]

A perforation is a hole in the eardrum.

Eardrum perforations are caused by middle ear infections and injuries.
Perforation causes sudden ear pain, sometimes with bleeding from the ear, hearing loss, or noise in the ear.
Doctors can see the perforation with an otoscope.
Usually the eardrum heals on its own, but sometimes surgical repair is needed.

A middle ear infection (otitis media) is the most common non-injury cause of eardrum perforation.
The eardrum can also be perforated by a sudden change in pressure, either

An increase in pressure, such as that caused by an explosion, an open-handed slap, or diving underwater
A decrease in pressure, such as occurs while flying in an airplane or when strong suction is applied to the ear canal

Severe head injury may cause a perforation, particularly if the base of the skull near the ear is fractured.
The eardrum may also be perforated (punctured) by objects inserted in the ear, such as a cotton swab, or by objects entering the ear accidentally, such as a low-hanging twig or a thrown pencil. An object that penetrates the eardrum can dislocate or fracture the chain of small bones (ossicles) that connect the eardrum to the inner ear. Pieces of the broken ossicles or the object itself may even penetrate the inner ear. A blocked eustachian tube, which connects the middle ear and the back of the nose, may lead to the perforation because of severe imbalance of pressure (barotrauma). A perforation may occur when doctors irrigate the ear canal or remove a foreign object.