Today I will discuss about ruptured or perforated eardrum due to trauma.
We will discuss its cause, diagnosis, treatment, etc.
The tympanic membrane, otherwise known as the eardrum, is a very thin structure that forms an airtight seal to separate the outer ear canal from the middle ear space.
As the vibration of sound travels down the ear canal, the eardrum’s job is to vibrate transferring the mechanical vibration of sound through the middle ear bones into the cochlea, which is where sound can be converted into a nerve impulse and sent up to the brain.
The eardrum itself is composed of 3 very thin layers of tissue:
1) Outer cutaneous layer.
2) Middle fibrous layer.
3) Inner mucosal layer.
All three of these layers combine to be only about 0.1 millimeters in thickness, which is about the thickness of a single strand of human hair, which leads us to a quite obvious problem, which is the eardrum is extremely easy to damage.
When this damage does occur, it can cause an immense amount of pain, leave you with a conductive hearing loss, and could possibly require surgery to treat.
What is RUPTURED EAR DRUM or TRAUMATIC PERFORATION?
A tear or hole in the EARDRUM due to trauma is called a TRAUMATIC PERFORATION.
You may find it hard to hear out of that ear or may hear a buzzing sound, or you may have an earache.
What are the Traumas or causes of ruptured eardrum?
1. Trauma: Trauma due to a hairpin, matchstick, or unskilled attempts to remove a foreign body, slap on the ear, fall from height, roadside accident, forceful syringing, etc.
2. Fluid buildup: If there is significant fluid buildup behind your eardrum in the middle ear space like someone would experience, perhaps, with otitis media, which is a middle ear infection.
If you get enough fluid buildup behind there, it could actually cause your eardrum to burst, much like poking a needle into a balloon.
3. Pressure changes: Extreme pressure can also cause your eardrum to rupture.
Sudden change in ear pressure, for e.g., a slap or a passionate kiss on the ear (where a sudden change in ear pressure occurs) or a sudden blast can lead to eardrum perforation.
We all have what is called a Eustachian tube and that Eustachian tube connects our throat to the middle ear space.
Now, the role of the Eustachian tube is to regulate the pressure inside of the middle ear to make sure that it is equal to the ambient air pressure outside of your ear. You may notice this regulation when you feel your ears pop when flying in an airplane. That is your Eustachian tube allowing air in and out of that middle ear space.
However, if you have sinus congestion or your Eustachian tube is not opening and closing like it normally should, you could build up a significant amount of pressure that can cause that eardrum to rupture.
4. Acoustic trauma: Loud sound can also cause a ruptured eardrum, like if you are exposed to an explosion or a really loud gunshot.
Sound is typically measured in sound pressure level. This means that sound actually creates a pressure change.
When you have an extreme pressure change, as you would experience with an explosion or a really loud gunshot, it can actually create so much pressure that it ruptures your eardrum.
5. Foreign objects: Now, I know a cotton swab might not necessarily be a foreign object to you, but it is absolutely a foreign object to your ear canal and when you take one of these and stick it inside of your ear canal, not only are you pushing wax further inside of your ear, you also run the risk of rupturing your eardrum, causing extreme pain and potentially dislodging the three middle ear bones.
So, keep cotton swabs, bobby pins, and car keys outside of your ear canals. Otherwise, you could have a really expensive date with a surgeon in the future.
6. Head trauma: If you had severe head trauma like being in a motor vehicle accident, that can also cause a rupture of your eardrum, and not only that, but it can also cause structural damage to those three middle ear bones and even your cochlea, which can dramatically impact how well you can hear.
7. Forceful Valsalva may rupture a thin atrophic eardrum.
8. Intentional: Now, there are occasions, where a ruptured eardrum is intentional, and this is when an ear, nose, and throat physician actually creates a perforation in of your eardrum (known as MYRINGOTOMY) in order to drain fluid outside of your middle ear space and then put a pressure equalization tube (GROMMET) in place and this often occurs mostly with children, but then you also have Transtympanic injections, which are really designed for individuals who have a sudden hearing loss in one ear. They actually go in and perforate the eardrum to inject a steroid into the middle ear space.
What are the symptoms of a perforated eardrum?
So, outside of these reasons, well first and foremost, you should be experiencing a lot of EAR PAIN.
Other than that, you could actually have a little bit of DISCHARGE coming out of your ear canals because of some fluid that is leaking through that perforation and you also may experience HEARING LOSS and TINNITUS.
- Sudden hearing loss.
- Pain in the ear.
- Itching in the ear.
- Otorrhea in which a secretion flows out of the ear.
How to diagnose Traumatic Eardrum Perforation?
A rupture is most easily identified by a comprehensive hearing evaluation known as PURE TONE AUDIOMETRY combined with visualization of the eardrum itself (OTOSCOPY) as well as TYMPANOMETRY, which tells us the mobility of the eardrum and the ear canal volume.
What are the complications of a ruptured eardrum?
There can be different complications, for example, the entry of bacteria into the hole and with that entry into the middle ear, so it can cause chronic and also recurrent infections.
This can lead to hearing loss, otitis media, which is the inflammation of the middle ear, cholesteatoma (creation of a kind of cell clump, which grows from the middle ear into the outer ear), subluxation of the ossicles which causes the ossicles to move over each other or fraction and also labyrinthitis.
How long does it take for a ruptured eardrum to heal?
Depending on the cause of the perforated or ruptured eardrum and the size of the perforation, the duration that it takes to heal varies, so if the perforation is a result of trauma, this usually heals within 4 to 6 weeks as long as no infection is introduced from the outside.
If it is usually delayed more than 4 to 6 weeks, I advise you to seek medical advice from your ENT specialist to see what would be the next course of action.
What important things a patient should keep in mind when the eardrum ruptures due to trauma?
The most important thing that a patient with traumatic perforation should keep in mind is that–
He should “KEEP THE EAR ABSOLUTELY DRY.” No water should enter his ear while bathing.
He should not instill any oil in his ear.
He should NOT even instill EAR DROPS till the doctor says so. (Ear drops are given if there is a concomitant infection in the ear, or if the ear starts discharging pus)
The belief is that if an ear is dry the chances of perforation healing spontaneously increase, however, the ear gets wet by water, oil, or even ear drops, the chances of spontaneous healing of traumatic perforation decreases.
What is the treatment of traumatic rupture?
Your eardrum should heal on its own in a few weeks, and you should hear normally then.
If you have an infection, the ENT doctor may prescribe antibiotics and painkillers which may help your earache.
ENT doctor will check to see if your eardrum has healed. If not, you may need surgery to repair the eardrum.
The treatment options for Traumatic rupture are –
1. Repairs Itself: If the rupture is small, it can heal itself. In a majority of cases, the edges of perforation get inverted towards the middle ear. In such cases, the ear should be examined under an operating microscope and the edges of the perforation repositioned and splinted.
2. Myringoplasty or Tympanoplasty: Myringoplasty is the repair of the tympanic membrane perforation.
Tympanoplasty: If you have a larger, more serious perforation, you may require a tympanoplasty, which is where a surgeon will remove a portion of a vein or the outer sheath of a muscle, make an incision behind your ear, pull that ear forward to get behind the eardrum and perform a graft of that material on the backside of your eardrum.
3. Urgent Exploration: Injuries of the tympanic membrane may be associated with facial paralysis or subluxation of stapes (vertigo and nystagmus) and sensorineural hearing loss. In such cases, urgent exploration of the middle ear may be required.
4. Splintage: It is used in fresh traumatic perforations. The torn edges of the perforation are carefully everted under the microscope and splinted with absorbable Gelfoam placed in the middle ear through the tear. Smaller tears can be splinted on the outer surface of the tympanic membrane with a piece of cigarette paper, Gelfilm or silicone sheet.
5. Ossiculoplasty: If the damage was caused to your three middle ear bones, then you may also have to go through an ossiculoplasty, which is basically where they restructure those three middle ear bones or they completely replace them with a prosthetic.
How can you care for yourself at home?
- If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
- Take pain medicine, such as Ibuprofen (Advil, Motrin), or Naproxen (Aleve), as advised by the doctor.
- Do not take two or more pain medicines at the same time.
- To ease pain, put a warm washcloth or a heating pad set on low on your ear. You may have some drainage from the ear.
- DO NOT TAKE over-the-counter cold or flu medicines.
- Keep your ears dry.
- Take baths until your doctor says you can take showers again.
- When you wash your hair, use cotton lightly coated with petroleum jelly as an earplug. Or ask your doctor about using earplugs.
- Do not swim until your doctor says you can.
- If you get water in your ears, turn your head to each side and pull the earlobe in different directions. This will help the water run out.
If your ears are still wet, use a hairdryer set on the lowest heat. Hold the dryer several inches from your ear.
- Do not put anything into your ear canal. For example, do not use a cotton swab to clean the inside of your ear. It can damage your ear. If you think you have something inside your ear, ask your doctor to check it.
When should you call for help?
You have signs of infection, such as:
- Increased pain, swelling, warmth, or redness.
- Pus draining from the ear.
- A fever.
Watch closely for changes in your health, and be sure to contact your doctor if:
- You have changes in hearing.
- You do not get better as expected.
Ultimately, a ruptured eardrum is no laughing matter. Sometimes, you can prevent them and sometimes you can’t.
Just remember, if you feel like you may have a ruptured eardrum, the best and the a wise thing that you can possibly do is consult an ENT doctor.
MEDICAL ADVICE DISCLAIMER:
This blog including information, content, references, and opinions is for informational purposes only.
The Author does not provide any medical advice on this platform.
Viewing, accessing, or reading this blog does not establish any doctor-patient relationship.
The information provided in this blog does not replace the services and opinions of a qualified medical professional who examines you and then prescribes medicines.
And if you have any questions of medical nature, please refer to your doctor or the qualified medical personnel for evaluation and management at a clinic/hospital near you.
The content provided in this blog represents the Author’s own interpretation of research articles.