Perforated Eardrum: Symptoms, Healing and Care

Quick answer

Most holes heal within about two months if the ear is kept dry and protected

Symptoms include sudden ear pain that may ease once the eardrum bursts, discharge (sometimes blood-stained), muffled hearing, ringing and occasionally dizziness. Common causes are middle ear infections, injuries from cotton buds or other objects, slaps or blows, explosions or very loud noises, and barotrauma from flying or diving. A doctor diagnoses it by looking with an otoscope. Most perforations heal by themselves within six to eight weeks. In the meantime keep water out of the ear, avoid putting anything in it, do not use ear drops unless prescribed, and avoid blowing your nose forcefully. Antibiotics may be needed if there is infection. Perforations that do not heal can be repaired surgically.

Important. Seek urgent care for a perforation after a head injury, severe pain, significant bleeding, sudden marked hearing loss, persistent dizziness or vertigo, weakness of the face, or fever with swelling behind the ear.

What is a perforated eardrum?

The eardrum (tympanic membrane) is a thin, cone-shaped membrane that vibrates with sound and passes those vibrations to the tiny bones of the middle ear. It also protects the middle ear from water and germs. A perforation, also called a ruptured eardrum or tympanic membrane perforation, can range from a pinhole to a large tear. Small holes may cause only mild symptoms, while larger ones affect hearing more and are less likely to close on their own.

Symptoms

Sudden ear pain, which may ease quickly when the eardrum ruptures during an infection.
Discharge from the ear: clear, pus-like or blood-stained.
Muffled or reduced hearing in the affected ear.
Ringing or buzzing (tinnitus).
A feeling of air passing through the ear when blowing the nose.
Dizziness or vertigo in some cases.
Repeated ear infections if a perforation persists.

Causes

Middle ear infection: pressure from pus behind the eardrum can make it burst; common in children.
Injury: cotton buds, hairpins or other objects pushed into the ear.
Barotrauma: sudden pressure changes during flying, diving or a blow to the ear such as a slap.
Loud noise: explosions or blasts.
Head injury, including skull fractures.
Long-term ear problems such as chronic otitis media.

How it is diagnosed

A GP or ENT doctor looks into the ear with an otoscope. If discharge blocks the view, the ear may be gently cleaned or reviewed a few days later. A hearing test may be done to assess any hearing loss. If the perforation followed a significant injury, or there is dizziness or major hearing loss, an ENT specialist will check for damage to the middle or inner ear. Fluid behind an intact eardrum can cause similar muffled hearing; see our guide to fluid in the ear.

How long does a perforated eardrum take to heal?

Most small perforations heal on their own within a few weeks, and the majority within six to eight weeks. Hearing usually returns to normal as the eardrum closes. Larger perforations, those caused by blasts or chronic infection, and perforations in people who keep getting ear infections are less likely to heal spontaneously. A follow-up check is usually arranged to confirm healing.

How to care for your ear while it heals

Keep the ear dry: avoid swimming, and when showering or washing hair, place a cotton wool ball coated in petroleum jelly in the outer ear.
Do not put cotton buds, fingers or anything else in the ear.
Do not use ear drops unless a doctor has prescribed ones that are safe with a perforation.
Avoid blowing your nose hard; if you need to, do it gently, one side at a time.
Take paracetamol or ibuprofen for pain if suitable.
A warm, dry flannel held over the ear may ease discomfort.
Avoid flying or diving if possible until it has healed, or ask your doctor.

Sleeping and daily life with a perforated eardrum

There is no strict rule about sleeping position. Many people find it more comfortable to sleep with the affected ear facing up, which may also help discharge drain onto a towel or pillowcase in the morning when they sit up. Keep the ear clean on the outside only. Most people can work and go to school as normal. Swimming should wait until a doctor confirms healing; some people with healed or long-standing perforations may later be advised to swim with ear protection. Questions about water after ear infections are covered in our guide on whether you can swim with an ear infection.

Medical and surgical treatment

If there is an infection, a doctor may prescribe antibiotic tablets or drops that are safe for use with a perforation. If the hole has not healed after a few months or causes repeated infections or hearing loss, an ENT surgeon may offer a myringoplasty or tympanoplasty, in which a small graft of the patient’s own tissue is used to close the hole. Small perforations can sometimes be patched in clinic. Success rates for surgery are high, and hearing often improves.

Three common situations

Child with earache that suddenly stopped and a wet pillow: the eardrum has probably burst from an infection; see a doctor, keep the ear dry and expect healing within weeks.
Cotton bud slipped while cleaning the ear: pain, bleeding and muffled hearing need an examination; most traumatic perforations heal without surgery.
Diver with ear pain and dizziness after ascent: barotrauma can affect the eardrum and inner ear; stop diving and get urgent ENT advice, especially if dizziness or hearing loss persists.

Key points to remember

A perforated eardrum causes pain, discharge, muffled hearing and sometimes ringing.
Most heal on their own within six to eight weeks.
Keep the ear dry and do not put anything in it.
Persistent perforations can be repaired surgically.

Questions about a perforated eardrum

These answers are general information and do not replace an examination or individual medical advice.

How do I know if my eardrum is perforated?

Sudden pain followed by discharge, muffled hearing and sometimes ringing suggest it. Only an examination can confirm it.

Can a perforated eardrum heal on its own?

Yes. Most small perforations heal within six to eight weeks if the ear is kept dry and protected.

Will I lose my hearing permanently?

Usually not. Hearing typically returns once the eardrum heals. Permanent loss is more likely after large injuries, blasts or inner ear damage.

Can I fly with a perforated eardrum?

Many people can fly, and an open perforation may even reduce pressure pain, but ask your doctor, especially if you also have an infection or dizziness.

Can I use ear drops with a perforated eardrum?

Only drops prescribed by a doctor who knows about the perforation. Some drops can damage the middle or inner ear.

Sources

This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.