Ruptured eardrum: symptoms, healing and treatment

The eardrum is a thin membrane that separates the ear canal from the air-filled middle ear behind it. The NHS ear infections page describes the middle ear as the area behind the eardrum, joined to the back of the nose by the eustachian tube. When the membrane tears or develops a hole, the condition is called a perforated, ruptured or burst eardrum.

The NHS says a perforated eardrum usually gets better on its own within 2 months, and hearing returns to normal. That is the usual outcome, which is reassuring for anyone who has felt a sudden pop followed by pain or hearing change.

Most of the time symptoms affect one ear.

The NHS says symptoms usually start suddenly after one of four things: an ear infection, an injury such as being hit on the ear, a loud noise, or a sudden change in air pressure, for example when flying.

Infection is a frequent route. The NHS ear infection page lists discharge running out of the ear and difficulty hearing among its symptoms, so it is worth telling a GP if either follows an infection.

Poking objects into the ear is a further risk, which is one reason the NHS advises not putting anything in the ear, including cotton buds.

The NHS lists hearing loss, a ringing or buzzing sound (tinnitus), earache or ear pain, itching in the ear, clear fluid, blood or pus leaking from the ear, feeling dizzy and a high temperature. Not every person has all of them.

Other conditions can look similar. The NHS glue ear page lists earwax build-up, an object stuck in the ear and a perforated eardrum, particularly after a loud noise or accident, among causes of ear pain with a change in hearing. That is why an examination is sensible when hearing changes suddenly.

• Sudden hearing loss in one ear after a bang, infection or pressure change.

• Tinnitus, itching, or discharge that may be clear, bloody or pus-like.

• Dizziness or a temperature, which suggest the ear may also be infected.

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 from the ear.

It adds that this might not be anything serious, but it is best to get help because it may need to be treated quickly. Sudden hearing loss can have causes other than a perforation, so waiting to see whether it improves is not a good plan.

See a GP if symptoms have not started to improve after a few weeks, the NHS advises.

Most perforations need no procedure. The NHS says you may need antibiotics if you have an ear infection, or to stop one developing while the eardrum heals. Painkillers such as paracetamol or ibuprofen ease the discomfort.

Sometimes surgery to repair the eardrum, called myringoplasty, is needed if it is not healing by itself. This is a decision for an ear, nose and throat specialist after the ear has been given time and observed. ENT UK provides information on myringoplasty, and the NHS points readers to it.

Flying is safe with a perforated eardrum, the NHS says. If you have had surgery to repair it, do not fly until you are told it is safe.

Keeping water out is the main task. The NHS advises a large piece of cotton wool covered in petroleum jelly in the outer ear when you wash your hair, and no swimming or getting the ear wet until the eardrum has healed.

Do not put anything inside the ear, such as cotton buds or eardrops, unless a doctor recommends them. Try not to blow your nose too hard, as this can damage the eardrum while it heals.

The NHS ear infection page adds that wiping discharge away with cotton wool is acceptable, but that you should not push anything into the ear to remove earwax.

A GP can look into the ear. The NHS advises going back if symptoms have not started to improve after a few weeks, and says surgery is sometimes needed if the eardrum is not healing by itself.

Hearing is expected to return to normal as the eardrum heals. If it does not, that deserves assessment rather than waiting, particularly if there is any dizziness or tinnitus that persists.

The NHS notes that ear pain with a change in hearing can have other causes, such as earwax or an object in the ear, so an examination is the way to be sure.