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Health condition · Clinically reviewed

Eardrum perforation, healing, aftercare and when repair fits.

Most perforations close on their own with a dry ear and time. The ones that don’t have a well-worn surgical answer.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against BAOHNS, NICE and peer-reviewed otology sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK ENT practice, including office-based repair, myringoplasty and audiology-led follow-up.

Key facts

Perforated eardrum at a glance.

The essentials, in plain English - what it is, why it happens, and how it is managed in the UK today.

  • What it is

    A tear or hole in the tympanic membrane (eardrum) that separates the ear canal from the middle ear.

  • Common causes

    Middle-ear infection (otitis media), barotrauma, cotton-bud injury and blast injury are the main ones.

  • Typical symptoms

    Sudden ear pain that eases after the drum ruptures, muffled hearing, discharge, tinnitus and sometimes vertigo.

  • Healing rate

    Around 60 to 80 per cent of traumatic and post-infection perforations heal on their own within three months.

  • Non-negotiables

    Keep the ear dry, avoid flying and diving, and never put cotton buds or drops in without ENT advice.

  • When to repair

    Perforations still open beyond three months, causing hearing loss or recurrent infection, warrant myringoplasty.

Why this guide matters

Time, dry ears, and knowing when to escalate.

Perforations are common and usually manageable. The three points below shape everything else on this page.

  • Most heal without surgery

    Around two-thirds to four-fifths of perforations close on their own within three months if the ear stays dry.

  • Cotton buds are the enemy

    Self-cleaning with cotton buds is a leading cause - keep everything out of the ear canal, always.

  • Myringoplasty works

    For persistent perforations, a graft repair has a success rate of 85 to 95 per cent and restores hearing.

How the diagnosis is made

From a sudden pop to a clear plan.

The steps a UK GP or ENT clinician will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    Focused history

    Trigger event (infection, flight, cotton bud, blast), timing, discharge, hearing change, tinnitus or vertigo.

  2. 02

    Assessing

    Otoscopy

    Direct view of the drum to size and locate the perforation - central, marginal or attic - and check for cholesteatoma.

  3. 03

    Assessing

    Tuning-fork tests

    Rinne and Weber at the bedside to confirm a conductive pattern of hearing loss.

  4. 04

    Confirming

    Pure-tone audiometry

    A formal hearing test to quantify conductive loss and rule out any sensorineural component.

  5. 05

    Confirming

    Rule out red-flag features

    Facial nerve weakness, severe vertigo, or a retraction pocket point to ossicular injury or cholesteatoma.

  6. 06

    Preparing

    CT temporal bone if indicated

    Reserved for trauma, suspected cholesteatoma, facial nerve involvement or planning surgery.

  7. 07

    Preparing

    Specialist ENT follow-up

    Otology review at six to eight weeks with repeat audiogram and otoscopy to confirm healing.

Typical timeline: from the first visit to a settled plan in a single clinic appointment.

Symptoms

What a perforated eardrum feels like.

The classic pattern of a sudden pop, muffled hearing and a little discharge - and the features that mean it is time to see ENT.

  • Sudden ear pain that eases

    Pressure builds behind the drum and pain often settles the moment the perforation occurs.

  • Muffled or reduced hearing

    A conductive hearing loss on the affected side, usually mild to moderate.

  • Discharge from the ear

    Bloody after trauma, or purulent when linked to middle-ear infection.

  • Tinnitus

    Ringing, hissing or buzzing in the affected ear that often eases as the drum heals.

  • Occasional vertigo

    Brief spinning after trauma may indicate round-window rupture and needs urgent ENT review.

  • Sensation of a blocked ear

    Fullness and popping while the middle-ear pressure re-equilibrates.

  • Recurrent ear infections

    Water or bacteria entering an unhealed perforation can cause repeated middle-ear infections.

  • Red flag - facial weakness

    Any facial droop, severe vertigo or profound hearing loss needs same-day ENT assessment.

Treatment

How eardrum perforation is treated in the UK.

Watchful waiting first, safe drops when infection intrudes, and myringoplasty or tympanoplasty when perforations persist.

  • Watchful waiting

    Most traumatic and post-infection perforations heal on their own within three months - keep the ear dry and review at six to eight weeks.

  • Keep the ear dry

    Cotton wool coated in Vaseline for showering, no swimming and no diving until an ENT clinician confirms healing.

  • Topical antibiotic drops

    Ciprofloxacin drops are the preferred non-ototoxic choice when there is discharge or ongoing infection.

  • Oral antibiotics

    Reserved for systemic symptoms or spreading middle-ear infection rather than as a routine measure.

  • Office-based paper patch

    A small paper or fat-plug patch placed in clinic can encourage healing of persistent dry perforations.

  • Myringoplasty or tympanoplasty

    Formal surgical repair using temporalis fascia or cartilage - the mainstay for perforations open beyond three months.

  • Ossicular reconstruction

    PORP or TORP prostheses restore the sound-conducting chain when the ossicles are eroded or disrupted.

  • Cholesteatoma surgery

    Tympanomastoid surgery removes the disease and, where possible, reconstructs hearing in the same operation.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or ENT clinician knows your ears and history and can tell you which parts apply to you. If in doubt, get seen.

  • British Association of Otorhinolaryngology, Head and Neck Surgery (BAOHNS). Otology guidance.

  • NICE Clinical Knowledge Summaries. Otitis media - acute and chronic suppurative.

  • ENT UK. Position papers on tympanic membrane perforation and myringoplasty.

  • MHRA. Guidance on ototoxicity of aminoglycoside ear drops in perforated ears.

Red flags

When a perforated ear needs urgent attention.

Most perforations settle. These are the situations where a specialist opinion cannot wait.

  • Facial nerve weakness

    Any facial droop with a perforated drum suggests deeper injury or infection and needs same-day ENT review.

  • Severe or persistent vertigo

    Ongoing spinning after trauma raises concern for round-window rupture or inner-ear involvement.

  • Profound or sensorineural loss

    A hearing loss out of proportion to the perforation points to inner-ear injury and needs urgent assessment.

  • Retraction pocket or attic crust

    Suggests cholesteatoma - a slow, silent condition that erodes bone and needs specialist surgery.

  • Chronic discharge beyond six weeks

    Persistent smelly discharge signals chronic suppurative otitis media and warrants ENT referral.

  • Penetrating or blast injury

    High-energy trauma can injure the ossicles, inner ear or facial nerve - full ENT assessment is essential.

  • Fever with severe ear pain

    May indicate complicated middle-ear infection or mastoiditis, especially in children.

  • Water exposure with an open drum

    Getting a perforated ear wet can seed a middle-ear infection and delay healing.

  • Hearing loss before a hearing aid

    A perforation should be repaired before fitting a hearing aid to prevent recurrent infections.

Living with it

A treatable problem, with clear ground rules.

Four things that make the biggest difference day to day - a dry ear, an empty ear canal, sensible travel and a proper recheck.

A quiet reminder

Patience heals more ears than any product.

Give the drum time, keep it dry, and let ENT decide whether to intervene - most perforations reward that patience.

  1. 01 Protect

    Keep the ear dry

    Cotton wool with Vaseline in the shower, no swimming and no diving until the drum has healed.

  2. 02 Avoid

    Nothing in the ear canal

    No cotton buds, no fingers and no over-the-counter drops without ENT advice - a leading cause of perforation is self-cleaning.

  3. 03 Travel

    Pressure changes matter

    Avoid flying and diving until an ENT clinician confirms healing - both can worsen an open perforation.

  4. 04 Review

    Come back for a recheck

    A six to eight week review with otoscopy and audiometry confirms healing or triggers the next step.

Frequently asked

Everything we get asked about eardrum perforation.

Quick answers on healing, safe drops, water, flying and surgical repair.

  • What is a perforated eardrum?

    A perforated eardrum is a hole or tear in the tympanic membrane, the thin drum that separates the ear canal from the middle ear. It can be caused by infection, sudden pressure changes, direct injury or surgery, and usually causes pain that eases quickly, muffled hearing and sometimes discharge.

  • Will a perforated eardrum heal on its own?

    In most cases, yes. Around 60 to 80 per cent of traumatic and post-infection perforations close on their own within three months, provided the ear is kept dry and infection is controlled. Perforations that are still open at three months usually need a small operation called myringoplasty.

  • Can I swim or fly with a perforated eardrum?

    No, not until an ENT clinician confirms the drum has healed. Water entering an open perforation can cause middle-ear infection, and pressure changes from flying or diving can enlarge the hole and delay healing.

  • Are ear drops safe when the eardrum is perforated?

    Only certain drops are safe. Ciprofloxacin drops are the preferred option because they are non-ototoxic. Aminoglycoside drops such as gentamicin can damage the inner ear if the drum is open and should only be used under ENT supervision.

  • What is myringoplasty?

    Myringoplasty is a day-case operation to repair a persistent perforation. The surgeon uses a small graft of temporalis fascia or cartilage from behind the ear to close the hole, usually improving hearing and preventing further infections. Success rates are typically 85 to 95 per cent.

  • When should I worry about my perforated eardrum?

    Seek urgent ENT review if you develop facial weakness, severe or ongoing vertigo, profound hearing loss, high fever with ear pain, or persistent smelly discharge. These can indicate ossicular injury, inner-ear involvement, cholesteatoma or complicated infection.

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