Perforated Eardrum: Symptoms, Causes and Treatment

Eardrum Perforation or a Tympanic Membrane Perforation is a hole or tear in the thin membrane (eardrum) that separates the ear canal from the middle ear. The eardrum is the part of the ear that receives vibrations from sound, allowing you to hear. Eardrum perforation can lead to loss of hearing and also can make the middle ear vulnerable to infections. 

The main symptom of eardrum perforation is pain. For some people, pain may remain steady throughout the day, or it can increase or decrease in intensity. Other signs and symptoms of an eardrum perforation may include:

1. Tinnitus (a noise, buzzing, or ringing in your ears)
2. Drainage from the ear (blood or pus-like)
3. Vertigo (spinning sensation), resulting in nausea or vomiting
4. Episodic ear infections
5. Facial weakness
6. A whistling sound in the ear while blowing the nose
7. Ringing in the ear
8. Decrease in hearing or hearing loss

Eardrum perforation can develop in any age group or gender. Below mentioned are some of the most common causes of eardrum perforation:

1. Acute otitis media (infection in the middle ear) 
2. Barotrauma (injury to your ears due to sudden changes in air pressure)
3. Sticking objects like a cotton swab or hairpin in the ear can puncture the eardrum
4. Acoustic trauma (loud sounds or blasts like explosions or gunshots)
5. Severe head traumas, like a skull fracture

An eardrum perforation develops when there is a tear in the eardrum. An individual may be at a higher risk of developing eardrum perforation if he/she has:

1. An ear infection
2. History of eardrum ruptures or ear surgery, such as ear tubes
3. Injury to the ear
4. Inserted objects in the ear
5. Done scuba diving

There are multiple things that an individual can do to prevent eardrum perforation. Some of the measures to prevent eardrum perforation are listed below:

1. Get treatment for middle ear infections
2. Protect the ears during flight
3. Keep the ears free of foreign objects
4. Guard against explosive noise
5. Use earplugs, chew gum, or force a yawn to keep your ear pressure stabilized

An ENT (ear, nose, and throat) specialist can diagnose a perforated eardrum using various methods such as:

1. Otoscope: Your healthcare provider will use a lighted instrument to view the ear canal.
2. Laboratory tests: If there’s discharge from the ear, the doctor may take a swab sample and send it for laboratory testing to detect bacterial infection in the middle ear.
3. Tuning fork evaluation: Tuning forks are two metal instruments that produce vibration and sound when struck together. The test is used to detect possible hearing loss. 
4. Audiology exam: The doctor uses this test to examine your hearing range and eardrum capacity at different pitches and volumes. 
5. Tympanometry: The doctor inserts a tympanometer into your ear to measure your eardrum’s response to slight changes in air pressure.

How to prepare for the doctor's consultation?

If an individual has signs or symptoms of a perforated eardrum, then consult the ear, nose and throat (ENT) specialist. Below mentioned are some of the information that a patient can prepare before the appointment with the specialist.

1. List down symptoms including any that may seem unrelated to hearing loss, fluid discharge or other ear-related symptoms.
2. List down the relevant events that may be related to the ear problems, such as a history of infections, recent ear injuries or head traumas, or recent air travel.
3. The patient should also tell the specialist the list of medications and supplements he/she takes.
4. Ask questions to the specialist. Some of the questions are as follows:
   1. Do I have a ruptured eardrum?
   2. What else could be causing my hearing loss and other symptoms?
   3. If I have a ruptured eardrum, what do I need to do to protect my ear during the healing process?
   4. What type of follow-up appointments will I need?
   5. At what point do we need to consider other treatments?

Most ruptured (perforated) eardrums heal without treatment within a few weeks. Your doctor may prescribe antibiotic drops if there's evidence of any infection. If the tear or hole in the eardrum doesn't heal by itself, treatment will likely involve procedures to close the tear or hole.

Eardrum Perforation treatment by home remedies

Home care tips for treating a perforated eardrum include:

1. Take pain relievers to ease the pain from eardrum perforation.
2. Place a warm, dry compress on the ear several times a day.
3. Do not blow the nose more than necessary, as blowing the nose can create pressure on the ear and hamper the healing process. 
4. Do not use over-the-counter ear drops unless the doctor prescribes them, as the fluid can get deep into the ears. 
5. Keep the ear dry while bathing or showering.
6. Refrain from cleaning the ears until they are healed completely. 

Please note that the selection of the treatment procedure is based on the severity of the condition and the doctor’s opinion. 

Eardrum Perforation treatment with surgery

1. Eardrum patch: It is done if there is a tear or hole in the eardrum that doesn't close on its own. An ENT specialist may seal it with a paper patch (or a patch made of other material). With this procedure, the ENT specialist may apply a chemical to the edges of the tear, which can promote eardrum healing, and then apply a patch over the hole. The procedure may need to be repeated more than once before the hole closes.
2. Tympanoplasty: If a patch doesn't result in proper healing, the ENT specialist determines that the tear isn't likely to heal with a patch, he or she may recommend surgery known as Tympanoplasty. In this procedure, the surgeon grafts a patch of tissue to close the hole in the eardrum. This is an outpatient procedure, where the patient can usually go home the same day unless medical anaesthesia conditions require a longer hospital stay. 
3. Myringoplasty: In this procedure, the perforation is fixed by placing a graft to patch up the eardrum. This procedure is also performed on an outpatient basis. 

Usually, a perforated eardrum heals on its own. But, if it does not heal on its own, it can worsen the symptoms and also affect your daily life. Untreated eardrum perforation can lead to uncommon problems such as:

1. Hearing Loss
2. Middle ear infection (otitis media): Infection and fluid accumulation can occur in the middle ear.
3. Middle ear cyst (cholesteatoma): a rare condition in which cysts (composed of skin cells and other debris) can develop in the middle ear.
4. Bleeding from ear
5. Yellow discharge from the ear

When to see a doctor?

The patient can consult the doctor if he/she experiences:

1. Ear pain
2. Hearing loss
3. Ringing of ear
4. Spinning sensation
5. Nausea and vomiting

In the fight to keep the body healthy and functional, vitamins and minerals play a vital role. Some of the minerals are also critical elements in improving hearing health. These include:

1. Potassium: regulates the fluid in the inner ear. Foods rich in potassium include potatoes, spinach, lima beans, tomatoes, raisins, apricots, bananas, melons, oranges, yoghurt and low-fat milk
2. Folic acid: helps the body to generate new cell growth and helps increase the circulation of blood in the body. Foods rich in folic acid include fortified breakfast cereal, liver, spinach, and broccoli.
3. Magnesium: acts as a protective barrier to hair cells in the inner ear when loud noises are emitted. Foods rich in magnesium include bananas, potatoes, spinach and broccoli.
4. Zinc: is known for increasing cell growth and healing wounds. Zinc-rich foods include cashews, almonds, peanuts, beans, and split peas.
5. Omega 3 Fats & Vitamin D: have anti-inflammatory and anti-ageing properties. Foods rich in Omega 3s include flaxseed oil, krill oil, salmon, and soybean oil.