Middle Ear

Perforated Ear Drum

The ear drum has three layers

  • the innermost layer is the mucous producing lining of the middle ear
  • the middle layer is an elastic fibrous layer, strong fibres are organised like a spiders web
  • the outer layer is the skin lining of the ear canal

There is no fibrous layer in the area above the eardrum (called the ‘attic’) this is the weakest area in a normal drum. If the ear drum is damaged the elastic layer does not reform as it heals – this becomes the weakest part of the drum.

What is it?

A perforation is a hole in the eardrum

What causes it?

Direct Injury

  • air pressure – loud explosion noise or a slap injury (jandal or hand to ear) – can cause an air pressure wave forceful enough to cause a perforation
  • foreign body – any object that can fit into the ear may injure the ear drum

Barotrauma (Aerotitis)

if people fly or dive with ETD (Eustachian Tube Dysfunction) the resulting abrupt, severe negative pressure can lead to fluid forming in the middle ear (effusion) or if the stretching of the eardrum is severe, bleeding of the capillaries within the eardrum and in extreme cases, immediate bursting of the eardrum


acute middle ear infections can lead to a pressured build up of puss which bursts out through the layers of the eardrum.

How does it affect people?

  • pain – immediate and usually severe with direct injury. Gradual increase as the eardrum stretches, with the increased pressure of a middle ear infection or with the negative pressure of barotrauma
  • hearing loss – small holes do not make a difference in hearing as the eardrum can still move well to transfer the sound waves. Large holes can lead to a 30-60dB hearing loss
  • weeping or discharging ear – infections occur because the protection of the eardrum is lost and water/soap etc can easily enter the middle ear through the perforation. Chronic infections slowly ‘eat’ away the eardrum and the hearing bones, leading to permanent hearing loss
  • healing – sometimes they heal quickly, sometimes over time and sometimes not at all
  • difficulty wearing hearing aids – the perforation allows moisture from the middle ear to come into the ear canal – increasing the risk of infection
  • not able to get ear wet – people with long term perforations learn it is easier not to swim a lot or to get their head under the shower as they want to avoid troublesome ear canal infections
  • not able to dive or snorkel – water going through the perforation into the middle ear causes infections easily

How to help yourself?

  • ears are best kept empty – call in regularly to TOLBECS or your Health professional to make sure, especially before a holiday, summer or a water sports trip
  • healthy ears need to be kept dry
    • flap or blow air in to keep moisture from building up
    • keep shower/bath water out of a perforated ear by using BluTak  as ear shields

How TOLBECS could help you?

  • acute episode – we gently clean any debris away, see an enlarged view of your eardrum and tell you what the damage is. We tell you all the ways you can help a perforation heal. We reassess your ears regularly and inform you of the healing progress.
  • running ears – during a discharging episode we meticulously clean the ear canal, take a sample of the infection to send to your GP who may wish to process it at the laboratory. Your GP may prescribe ear drops to kill the pathogens causing the infection. We will tell /show you what we see and what we recommend you do to increase the likelihood of healing.
  • long standing perforations – if the perforation is dry but preventing you from leading your normal full life, we can refer you to an ENT specialist who may consider surgical patching of the perforation