There'a Hole in My Ear Drum. Now What?

“A hole in the eardrum may not be as complex as some ailments, but it does make a big impact on quality of life and can become serious over time,” says Ear, Nose & Throat (ENT) otologist Paul R. Lambert, M.D.

The eardrum is about the size of your first fingernail. A hole can range in size from a very small puncture to the entire eardrum. A small hole may heal itself naturally, but most cases require surgical repair.

A perforation needs to be repaired for three reasons. First, the middle ear behind the eardrum becomes more prone to infection. Infection occurs as germs pass through the opening, usually carried there by water in the ear canal. Second, eardrum holes often cause hearing loss, since sound is not properly conducted into the cochlea (inner ear where sound is processed). Third, recurrent infection, evidenced by drainage, can cause further harm, such as damage to one or more of the the three middle ear bones, adding an additional layer of complexity to the repair process.

No two eardrum holes are the same, as several variables play a role in each case. For example, the ear canal shape and position of the eardrum hole can affect access to the hole. If skin has grown through the hole or if the ear bones have been affected, the condition becomes more complex.

What causes a hole in the eardrum?

Eardrum holes occur in adults and children alike. For adults, a perforation is most commonly caused by an infection. It can also be caused by trauma to the ear drum from a foreign object. For children, a hole is most commonly caused when ear tubes are removed and the residual hole doesn’t heal properly.

“At MUSC Health ENT, eardrum surgery is the most common type of surgery we do within the otology division. We conduct at least two to three eardrum surgeries per day with a ninety percent success rate,” says Dr. Lambert. “We’ve seen it all. I’ve seen incidents involving a cotton swab that went too far, an inconveniently placed twig during a walk in the woods, and a skiing accident where water penetrated the eardrum.”

While people are not typically prone to weak eardrums, repetitive infections could cause weakening. Health issues like diabetes can make a person more prone to infection or reduce blood flow, complicating the healing process. Smoking can also complicate the healing process.

“Twenty-five to thirty percent of eardrum surgeries performed at MUSC Health ENT are revisions where the initial surgery didn’t take because of technical failure or an infection developed during the healing phase,” says Dr. Lambert. “I’ve had patients referred to me who are on their third or fourth attempt.”

What is the best treatment for a hole in the eardrum?

If you have a hole in the eardrum, try to avoid water in the canal. Create a plug with Vaseline coated cotton when showering and take special care not to immerse your ears when swimming. If you experience hearing loss or recurrent infection, or your condition is persistent or worsens, please seek medical attention.

The process to diagnose a hole in the ear drum is non-invasive and takes just seconds with an ear scope. Ninety percent of cases require surgery and the most common technique for repair involves a graft using cartilage or tissue from beneath the skin. It’s an outpatient procedure that takes 90 minutes to two hours and the patient can return to work within a few days.

MUSC ENT would be pleased to assist you or your loved ones. Please give us a call at 843-792-3531 to schedule an appointment with our team. We look forward to meeting you, to help you on your path to a healthy quality of life.o