Perforated eardrum: symptoms, healing time and treatment

The NHS says symptoms of a perforated eardrum usually start suddenly after an ear infection, an injury (such as getting hit on your ear), a loud noise, or a sudden change in air pressure (such as flying on a plane). Most of the time the symptoms affect one ear.

If you are not sure it is a perforated eardrum, the NHS suggests looking at other conditions that can cause earache, hearing loss or tinnitus. On its earache page, the NHS lists a perforated eardrum, particularly after a loud noise or accident, as one possible cause of ear pain with a change in hearing, alongside glue ear, earwax build-up and an object stuck in the ear.

• Hearing loss.

• A ringing or buzzing sound in the ear (tinnitus).

• Earache or ear pain.

• Itching in the ear.

• Clear fluid, blood or pus leaking from the ear.

• Feeling dizzy.

• A high temperature.

The NHS says a perforated eardrum usually gets better on its own within 2 months and your hearing returns to normal. You may need antibiotics if you have an ear infection, or to stop you getting an ear infection while your eardrum heals.

Sometimes surgery to repair the eardrum (myringoplasty) may be needed if the eardrum is not healing by itself. ENT UK explains that a perforation may be monitored for a period after a recent injury or infection, since some holes heal on their own, and that if a hole is not causing symptoms you may decide not to have surgery.

ENT UK says that for infections that keep coming back, the ear may be cleaned regularly under a microscope and antibiotic drops used, usually in an ENT clinic. If hearing is affected and you do not want surgery, a hearing aid may be considered.

The NHS lists things that help a perforated eardrum heal and ease symptoms.

• Take painkillers such as paracetamol or ibuprofen to ease pain.

• Put a large piece of cotton wool covered in petroleum jelly in your outer ear when you wash your hair, to stop water getting in.

• Do not go swimming or get your ear wet until your eardrum heals.

• Do not put anything inside your ear, such as cotton buds or eardrops, unless a doctor recommends them.

• Try not to blow your nose too hard, because this can damage your eardrum as it heals.

The NHS says it usually gets better within 2 months. It also says to see a GP if your symptoms have not started to improve after a few weeks, because some eardrums do not heal by themselves and may need a repair.

ENT UK says quite often holes in the eardrum heal by themselves and some do not cause any problems. Holes can range from small to large enough to affect the entire eardrum, and larger holes may reduce hearing. A perforation that does not close can cause discharge from the ear, especially if water gets in, and recurring infections.

The NHS lists four triggers: an ear infection, an injury such as being hit on the ear, a loud noise and a sudden change in air pressure. ENT UK says holes in the eardrum can be caused by an infection or injury to the eardrum.

NHS inform explains that middle ear infection causes a build-up of fluid behind the eardrum, and that in some cases a hole may develop in the eardrum (perforated eardrum) and pus may run out of the ear. The earache, caused by fluid stretching the eardrum, then resolves. It adds that rarely, infections can leave a perforation or hole.

The NHS says to ask for an urgent GP appointment or get help from NHS 111 if you have sudden hearing loss in one or both ears, your hearing has been getting worse over the last few days or weeks, or you have hearing loss along with other symptoms such as earache or discharge coming out of the ear. It says it might not be anything serious, but it is best to get help as it may need to be treated quickly.

NHS inform advises speaking to your GP practice for ear infection symptoms that do not improve within 2 or 3 days, regular ear infections, a lot of pain, or a discharge of pus or fluid from the ear. If the GP practice is closed, phone 111.

The NHS pages do not list a perforated eardrum on its own as a 999 emergency. If you feel very unwell, use NHS 111 for advice, and call 999 if you think it is an emergency.

ENT UK says the benefits of surgery to close a hole include preventing water getting into the middle ear, which reduces the chance of infection and stops the ear leaking discharge. It adds that repairing the eardrum alone does not usually lead to a great improvement in hearing.

The operation is usually performed under general anaesthetic, and a graft taken from under the skin or from the lining and cartilage in front of the ear canal is used to patch the hole. Many hospitals perform it as day surgery, and recovery time is usually a few days, with up to one or two weeks off work as a guide.

ENT UK says that for small holes the operation works well nine times out of ten, and that factors such as smoking can affect success. Risks include altered taste, dizziness, hearing loss (rare, severe deafness if the inner ear is damaged), tinnitus, temporary facial weakness and allergic reaction to the dressings.

Most people start with a GP, who can look in the ear and decide whether antibiotics or a hearing test are needed. If the eardrum does not heal, the GP can refer you to an ear, nose and throat (ENT) service, where an ENT specialist examines the ear with a special instrument called an otoscope, and a hearing test (audiogram) may be arranged, as ENT UK describes.

Some people choose to see a private ENT specialist or have a hearing test privately. If you do, the same advice about keeping the ear dry applies, and it is sensible to let your GP know the outcome so your records stay together.