Definition

The human ear is composed of three primary parts: the outer ear, middle ear, and inner ear. Sound vibrations enter through the outer ear, causing the eardrum to vibrate. These vibrations are transmitted through the middle ear and auditory ossicles to reach the inner ear.

The eardrum acts as a barrier between the outer and middle ear. Any eardrum tear, rupture, or perforation can interfere with sound transmission to the middle and inner ear. This condition not only hinders sound transmission but can also lead to infections.

Various factors can cause a ruptured eardrum, including infections, injuries, and sudden changes in ear pressure. While most cases of ruptured eardrums occur immediately without complications, some develop gradually, potentially leading to various complications.

A ruptured eardrum can occur at any age but is more common in younger individuals. In the younger population, ruptures often result from acute otitis media, while in older individuals, they are typically due to accidents or injuries to the tympanic membrane. The incidence is higher in men compared to women.

Causes

A ruptured eardrum can result from multiple factors such as complications of ear infections (acute otitis media or otitis externa caused by the fungus Aspergillus niger), barotrauma from explosions, scuba diving, or air travel. Ruptured eardrum can also be caused by head injuries, exposure to excessively loud noises, and insertion of foreign objects like broken glass or insects into the ear, among other unidentified causes.

Risk factor

• Exposure to loud noises without ear protection
• History of prior untreated ear infections
• Usage or insertion of small objects into the ear, potentially causing eardrum tears

Symptoms

Symptoms of a ruptured eardrum are generally consistent regardless of the cause. These symptoms include sudden pain that could be followed by a sensation of relief and fluid discharge from the ear. Additionally, ringing in the ears and symptoms of dizziness or vertigo may occur.

Diagnosis

The doctor will inquire about your symptoms, such as ear discharge, ear pain, and tinnitus. Additionally, the doctor will investigate your medical history, such as prior head injuries, exposure to loud noises, and episodes of vertigo.

Physical Examination 

The doctor may use an otoscope to examine and evaluate the ear directly.

Diagnostic Tests 

Following the medical interview and physical examination, the doctor may perform several diagnostic tests to help finding the diagnosis:

• Laboratory test. A sample of the ear discharge will be examined in the laboratory to help identify whether the condition is caused by microorganisms infection.
• Tuning fork test. This test assesses hearing loss.
• Pneumatic otoscopy. This test involves inserting a device into the ear to measure the eardrum's response to changes in air pressure.
• Audiology exam. This test evaluates the hearing function.

Physical Examination

The doctor may conduct an examination using a device called otoscopy. This examination is carried out to see and directly assess your outer ear.

Supporting Examination

After conducting a diagnosis and physical examination, the doctor will conduct a supporting examination. Several supporting examinations can be carried out to assist your doctor in enforcing a diagnosis in the form of:

• Laboratory examinationThis examination is carried out by taking samples from the fluid coming out of your ears. This liquid is then taken to the laboratory to identify the germs causing the burst eardrum.
• Examination using a tara forkThis examination was carried out to assess hearing loss.
• Examination with pneumatic otoscopy. This examination is carried out using a tool that is inserted into your ears. This tool will then measure the eardrum response to changes in air pressure.
• Audiological check. This examination is carried out to assess your hearing.

Management

Typically, ruptured eardrums heal without intervention. However, the doctor will determine if an infection is the cause of the condition. If an infection is present, treatment will be directed at the specific pathogen that causes the infection, along with medications to alleviate symptoms, such as pain relievers.

Should the eardrum perforation be significant and still have not healed after several weeks, the doctor may suggest surgical procedure. An otolaryngologist will perform the surgery to repair the ruptured eardrum.

To minimize the risk of ruptured eardrums from getting infected, here are the things you could do:

• Avoid inserting objects to your ears, including cotton swabs or ear drops, unless a doctor advises.
• Protect the ears from water by avoiding swimming and being cautious during showers or hair washing.
• Refrain from forceful nose-blowing or snorting to prevent further damage to the eardrum.

Complications

Potential complications from a ruptured eardrum include hearing loss. If left untreated, this condition may lead to chronic otitis media, resulting in infections that damage the auditory ossicles. Moreover, this could potentially cause permanent sensorineural deafness.

Additionally, prolonged or recurrent infections in the ear can impact nerve function. The seventh cranial nerve innervates the middle ear and the facial muscles, and disruption of this nerve can lead to facial muscle paralysis.

Infections can also extend from the ear into the cranial cavity, leading to serious conditions like meningitis or brain abscess. An abscess, characterized by pus accumulation due to infection, poses a significant health risk to patients.

Another complication from ruptured eardrums is mastoiditis, an inflammation of the mastoid bone that forms parts of the ear wall. Additionally, cholesteatoma, which involves abnormal skin cell growth in the middle ear, can occur. Cholesteatoma can erode middle ear bones and damage the inner ear, resulting in vertigo and permanent hearing loss.

Prevention

To protect your eardrums, there are steps that you can do, such as:

• Use earplugs to protect your ears in loud environments.
• Avoid inserting objects into your ears that might rupture your eardrum.
• Seek prompt medical attention if you experience ear pain or symptoms of an ear infection.

When to see a doctor?

Consult a doctor if you suspect a ruptured eardrum or have persistent ear-related symptoms to get your ears treated. If symptoms such as pain, fever, or ear discharge do not resolve, immediate evaluation is necessary.

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