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GaramChai features Medical articles by Dr.Kumaresh Krishnamoorthy
Your ears are divided into three parts: The outer ear, middle ear, and inner ear. Your eardrum is a small circular membrane covered in a thick layer of skin, which is located between the outer and middle ear. A perforated eardrum is a hole or a tear in your eardrum.
Sound waves come into your outer ear, and make your eardrum vibrate. These vibrations then pass from your eardrum to tiny bones in your middle ear, where they are passed to the cochlea in your inner ear. Your cochlea then converts the vibrations to sound signals, which are sent to your brain so you can 'hear' sounds.
Symptoms of a perforated eardrum include earache and hearing problems, and it is usually caused by an ear infection or by putting an object into your ear. A perforated eardrum usually heals by itself, although sometimes surgery is required.
If you have a perforated eardrum, you may get the following symptoms in the affected ear:
- earache, or discomfort,
- discharge of liquid or pus from your ear,
- partial loss of hearing, and
- buzzing, ringing or other noises in your ear.
If a perforated eardrum is caused by another condition, you may get other symptoms associated with that condition. For example, symptoms of an ear infection can include a sore throat, and a high temperature.
A perforated eardrum is normally caused by an ear infection. This is because pus can build up in your ear when you have an infection, so your eardrum ruptures to allow the pus to escape.
Sudden changes in air pressure can also cause a perforated eardrum. This can be caused by a sudden loud noise such as an explosion, by underwater diving, or when flying.
A perforated eardrum can also be caused by putting objects deep in your ear, such as cotton buds, and by a chronic disease of the middle ear (cholesteatoma). Very rarely, a perforated eardrum can be caused by a fracture to the skull, or tumor near the ear.
If you have pain or discomfort in your ear for more than a couple of days, you should see your doctor. They will examine your ears with an otoscope. An otoscope is a piece of equipment that uses a light and a magnifier to see inside your ear. If your eardrum is perforated, your doctor will be able to see an opening or tear on your eardrum (see color picture above).
A perforated eardrum should heal by itself within around one to two months. In the meantime, you can relieve any pain by taking painkillers such as paracetamol. Warming your ear with a hot water bottle wrapped in a towel may also relieve any discomfort.
While your ear is healing, you should avoid getting water inside it. Wear a shower cap over your ears, or cotton balls in the affected ear while you shower, and don't swim or put your head underwater.
If a perforated eardrum is caused by an infection, you may be prescribed antibiotics. Once the infection is treated, the perforation can heal.
You should get your doctor to check your ear after a few weeks to make sure it is healing. If it doesn't heal on its own, surgery may be required. This is called a myringoplasty.
If you have a myringoplasty, you will be admitted to hospital. The time you will spend in hospital varies from a few hours to two days, depending on your circumstances. You will be under general anesthetic when the surgery is carried out. A small cut will be made in the skin above you ear, and small piece of tissue will be taken to seal up the hole in your eardrum. This is called a graft. Then, the surgeon will use a microscope and very small surgical equipment to lift up your eardrum, and spread the graft beneath it so it seals up the hole. Sometimes, they may make an incision behind the ear so they can access your eardrum more easily.
After the operation, a dressing will be put inside your ear, and cotton wool padding will be put over your ear and held in place with a bandage. This may produce a buzzing or popping sound in your ears. You will have to return to the outpatient clinic at the hospital several weeks after the operation to have your dressings removed, and to have your ears checked. If you have had stitches, you may have to return earlier to have them removed.
After the operation, you may have to take painkillers to ease any discomfort. You should keep any wounds dry until they have healed, and keep your ear dry. You should also avoid swimming or flying until your doctor says it is safe to do so. You may feel tired for a week or so after the operation.
In very rare cases, a myringoplasty can make hearing worse. There is also the risk of permanent damage to the nerves around the ear, but your surgeon will explain the risks to you before you have an operation.
Krishnamoorthy, M.S (ENT)
Head and Neck Surgery Fellowship (Buffalo, USA)
Neurotology & Skull Base Surgery Fellowship (Cincinnati,
Senior Consultant in ENT - Head and Neck Surgeon and Skull Base
Apollo Hospitals, 154/11, Bannerghatta Road, BANGALORE 560 076,
Phone: 91-(0) - 99002 36819