Hole in the Eardrum (Tympanic Membrane Perforation) and Repair
by Dr. Christopher Chang, last modified on
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
- Ear tube placement
If the perforated eardum occurred suddenly (ie, traumatic, barotrauma, ear infection), treatment is initially with antibiotic ear drops +/- steroids. In over 90% of cases, the traumatic perforated eardrum will heal closed within 2 months [link].
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 (Underlay and Overlay Techniques) - Watch Video
containing actual surgical footage. This video is animation only.
- High success rate, but requires general anesthesia performed in the operating room. In this surgical procedure, a new eardrum is harvested from the patient's own body tissue (temporalis fascia or tragal perichondrium).
- Hyaluronic Acid Fat Graft Tympanoplasty
- Relatively new technique which has a reasonably high success rate (almost as good as traditional tympanoplasty) and can be done under local alone, though our preference is under sedation. In this procedure, fat tissue taken from behind the neck is used to act as a scaffold for epithelial cell migration stimulated by an overlying EpiDisc (hyaluronic acid). Link
Keep in mind that just because a hole in the eardrum does not heal closed does not mean it must be fixed. If there is minimal or no hearing loss present and the ear does not easily get infected, one can actually live with the eardrum perforation without consequence. However, if there's a significant hearing loss or the ear chronically gets infected with drainage requiring frequent treatment with antibiotic ear drops, fixing the eardrum perforation would help correct these issues.
Free online hearing test to determine if hearing loss may be present!
Here are cartoons to describe the differences in how these procedures are perform.
This is what a NORMAL ear looks like without a hole in the tympanic membrane (eardrum).
Image taken (and modified) from Wikipedia.
Hole in the Eardrum
Paper Patch Technique
Paper patch technique involves putting a thin membrane (film paper, gelfoam, etc) OVER the eardrum hole.
The paper patch is the thin purple stip.
In the underlay technique (also known as medial tympanoplasty), patient's own tissue (temporalis fascia) is used as a graft to reconstruct the eardrum by laying it UNDER the eardrum and ear canal wall skin.
The eardrum graft is the thin purple stip.
Watch a video with actual surgical footage of this repair technique.
In the overlay technique (also known as lateral tympanoplasty), patient's own tissue (temporalis fascia) is used as a graft to reconstruct the eardrum by laying it OVER the eardrum extending from placement UNDER the ear canal wall skin.
The eardrum graft is the thin purple stip.
Hyaluronic Acid Fat Graft Tympanoplasty
In the Hyaluronic Acid Fat Graft Tympanoplasty technique, fat tissue is obtained from neck near the ear. This fat tissue (shown in yellow) is placed in the middle ear space and used as a scaffold for new eardrum growth to occur over 2-6 months. This growth is stimulated by a hyaluronic acid disc (EpiDisc) shown in purple.
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)!
If lots of ear drainage is present, tissue spears can be used to remove as much drainage as possible.
Check out our online store of ear plug products.
The video below is an animation of how a hole in the eardrum is fixed. Actual surgical footage can be watched in this video.
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