Burst Ear Drum (Burst eardrum) in Adults
Disease/Disorder Name: Perforation of the Eardrum
ICD-9 Description: Perforation, Central, Tympanic membrane
ICD-9 Code Family: 384.2
Description: Perforation of the eardrum is a rupture of the tympanic membrane. Also called a “Burst Eardrum”.
|A healthy ear drum – note the pink, healthy look||
A burst ear drum – notice the raw, inflamed look which also denotes an infection
Causes of a burst eardrum
External Causes of a Burst Eardrum
An external cause for a burst eardrum is a head trauma such as a blow to the ear or an object penetrating the ear canal and penetrating the eardrum. An immediate trip to the emergency room is mandatory. The following information concerns minor eardrum damage fram an external source with no penetration into the middle or inner ear.
Usually, the larger the perforation, the greater the loss of hearing. The location of the hole (perforation) in the eardrum also effects the degree of hearing loss. If severe trauma (e.g. skull fracture) disrupts the bones in the middle ear which transmit sound or causes injury to the inner ear structures, the loss of hearing maybe quite severe.
With a traumatic or explosive event, the loss of hearing can be great and ringing in the ear (tinnitus) may be severe. In this case the hearing usually returns partially, and the ringing diminishes in a few days.
Side effects of a perforated eardrum (burst eardrum) will definitely be excruciating pain. You will probably also suffer from vertigo and/or tinnitus
If a burst eardrum fails to heal (3-4 weeks) you may need a tympanoplasty to repair the eardrum. The perforated eardrum can also be treated by an operation called a myringoplasty, where a tissue graft is used to seal up the hole. These procedures are discussed below.
Internal Causes of a Burst Eardrum – Otitis Media
Perforated eardrums from internal causes are usually from middle ear infections (otitis Media) (viral or bacterial). Why? Detritus from the infection in the inner ear (think bacteria or viral doo-doo) causes pressure to build in the middle ear cavity and if not relieved by draining through the Eustachian tube, the eardrum will burst outward.
Burst Eardrum Symptoms from internal causes
- Sharp pain as the eardrum bursts, then initial pain relief.
- Pus discharge from the ear, and usually very smelly
- Bleeding from the ear
- Hearing loss
- Throbbing pain as the middle and inner ear is subject to direct contact with the air
Outpatient treatments for a burst eardrum
OK. Your eardrum just burst . If you have had a middle ear infection that pushed out the eardrum, then the throbbing pain has been greatly diminished. Wipe off the smelly pus with a damp cloth, and lie quietly on your stomach with your neck on a firm pillow and your head turned so the ear that just burst is facing downward. Place a warm, damp cloth, or a hot water bottle wrapped in a towel underneath the ear.
Take one or two ibuprofen (Tylenol® et al) or aspirin to minimize the throbbing. Try to take a nap for an hour or two. When you wake up or start to get up, stand up slowly as you may have residual vertigo.
If you can tolerate a few days of associated vertigo, dizziness, and dull pain from the open ear drum, you may not need to see a doctor as the hole will in all likelihood heal on its own. It will depend on the size of the hole, and the extent of the inner ear infection. If you still don’t feel good after three days or if you still have a fever, it probably means the middle ear infection is still present and needs to be treated.
Antibiotics are usually prescribed, sometimes initially by injection, then a regimen orally three times a day for at least 7 days. In children, a penicillin-derivative called Amoxicillin® or Augmentine® is often used. Pediazole®, a brand-name combination of Erythromycin® and sulfisoxazole® can be used if you are allergic to penicillin or penicillin-derivative products.
Note: In the past, antibiotics such as penicillin, erythrocyn, or erythromycin were prescribed. However, in the last few decades, many in the general population have become immune to the effects of these antibiotics, and stronger ones are often prescribed. (The cause of immunity is often blamed on the same antibiotics fed to the food supply (chickens and beef)) before they are brought to market. The most common antibiotics in use today are doxycycline™ and Cipro™
If a hole in the eardrum does not close naturally within two weeks, it should be closed by other methods ASAP to prevent the possibility of water entering the ear while showering, bathing, or swimming (which could reinitiate an ear infection or exacerbate an already present ear infection).
The Healing Process for a Burst Eardrum
As the eardrum heals and the opening closes, you will probably notice a marked improvement in your hearing over the prior days. Any vertigo, dizziness, tinnitus and pain should slowly abate. A healthy healing eardrum may also prevent the development of a cholesteatoma (skin cyst in the middle ear), which can cause chronic infection and destruction of the ossicles.
Small perforation – possible procedures:
- If the perforation is very small and it does not heal after 2-3 weeks, an ENT (Ear, Nose, and Throat specialist) may still decide not to operate and allow nature to take its course and let the eardrum heal naturally.
Myringoplasty (minor outpatient surgery)
- There are a variety of surgical techniques to close a hole from a burst ear drum, but basically all procedures attempt to encourage the body to heal the opening. Procedures performed through the outer ear canal are called Myringoplasties. This type of surgery is typically quite successful in closing most perforations permanently. There are two types of surgeons qualified to perform ear drum repair operations: an ENT (Ear Nose Throat surgeon), and Head and Neck surgeons.
- A myringoplasty is usually done as a day-surgery local or mild general anesthesia basis in about 20 – 30 minutes. The surgeon will “clip” a small patch from under the skin behind the ear. This layer is called the dermis and is still “alive” and will assist with the healing of the ear drum. With small instruments, the surgeon will go through the ear canal and delicately attach the live skin tissue to the outside of the hole. It will not completely cover the hole to encourage new skin growth.
- Another myringoplasty technique used to encourage a ear drum to heal is to add a chemical (usually hyaluronic acid) to the edges of the hole to stimulate growth and instead of live tissue, a thin paper patch is placed on the eardrum to act as a basis for skin growth. Several applications of the patch (up to three or four over 3-6 weeks) may be required before the perforation closes completely. If these procedures are just not working, surgery under general anesthesia is usually recommended called a Tympanoplasty.
Long Term Effects of a Burst Eardrum on Hearing
The long term effects of a burst eardrum and subsequent operations on the ear will be a function of the size of the hole that was repaired, and how many times the eardrum has to be worked on before the hole is completely healed. With any tissue that heals, there is scar tissue residue; with any operation on body tissue, there is also scar tissue residue. Scar tissue is the natural end-result of a successfully healed eardrum.
The eardrum’s purpose is to vibrate. the buildup of scar tissue inhibits that vibration function; the greater the scar tissue, the less the eardrum will vibrate, affecting the ability to hear. As a rule of thumb, a hole in the eardrum that heals on its own within a few weeks or months will have minimal effect on hearing. However, continual operations on the ear drum will build up scar tissue and could cause severe hearing loss due to the subsequent scar tissue making the tympanic membrane inflexible.
A myringoplasty should only affect hearing loss to a maximum of 5%. Then again if the surgeon does an excellent job with a tympanoplasty and the hole is relatively small, hearing loss will be negligible. If there is more serious additional damage to the ossicles in the middle ear requiring an operation, the results could affect hearing quite negatively.