Ear Topics 
Hole in the Eardrum (Tympanic Membrane Perforation)
by Dr. Christopher Chang, last modified on
11/25/11
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A hole in the eardrum is also known as tympanic membrane perforation. Other synonymous terms are perforated eardrum & ruptured eardrum. There are several reasons why this may happen including:
- Trauma (getting slapped over the ear or deep q-tip insertion, etc)
- Severe ear infection
- Barotrauma
- Ear tube placement
If the perforated eardum occurred suddenly (ie, traumatic, barotrauma, ear infection), treatment is initially with antibiotic ear drops +/- steroids. In the vast majority of the time, the perforated eardrum will heal closed over the ensuing weeks.
If the eardrum does not heal closed spontaneously with time or the hole has been present for longer than 4-6 months, a surgical procedure can be performed to close the hole either by:
- "Paper" patch
- Medium success rate, but very easy to perform with minimal risks. The "paper" patch is in essence a very thin paper or alternative material (ie, gelfoam, fat, steri-strip, etc) placed over the hole the the edges are cleared of scar tissue. The paper patch acts as a scaffold to help the cells "cross" the hole over to the other side for closure.
- Tympanoplasty
- High success rate, but requires general anesthesia performed in the operating room. In this surgical procedure, a new eardrum is made from the the patient's own body tissue.
Surgery is generally not recommended (even if a persistent hole in the eardrum is present) unless one (or both) of the following conditions are present:
- Documented significant conductive hearing loss by audiogram
- Recurrent ear infections
If these two conditions are absent, surgery is typically not recommended. Why? Just because there's a hole doesn't mean it has to be corrected unless it is causing a functional problem (just like a bunion of a foot doesn't have to be corrected unless it's causing problems).
In rare cases, a perforated eardrum over a period of years to decades may predispose a patient to cholesteatoma (akin to a skin cyst) which would require surgical removal.
Of course, if a perforated eardrum is present, do NOT use any over-the-counter ear drops or use any type of earwax removal liquid as these medications may cause a horrific earache as well as put your hearing at risk (permanently)!
Picture of a Perforated Eardrum (Hole is on Bottom)
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If you have a perforated eardrum, please contact our office for an appointment.
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