Ear drum perforation – Treatment Options

From our first article, you now understand what might cause a perforated eardrum. Patients with perforated eardrum/s  are likely to suffer from one /both of two related problems. The first is a reduction in hearing as the eardrum is unable to capture the sound waves and effectively translate this into hearing. With some patients, this might be accompanied by a ringing noise in the ear called tinnitus. This happens as our inner ear has a background nerve discharge or “noise” which appears louder when outside voices or environmental noise no longer can enter as well and cover it.

The second condition is a recurrent and infectively discharging ear especially after showering or swimming. This is because the usually middle ear cavity is now easily contaminated from the outside. The perforated eardrum no longer forms an effective seal and barrier of protection for the middle ear cavity.

So what can be done? Usually surgery is undertaken to repair a perforated eardrum that has not healed. This surgery is called a “myringoplasty” which in Latin means myringo = ear drum ; -plasty = repair. This repair can be undertaken either under local or general anesthesia, depending upon the size of the hole and the patient’s condition. In most instances, it is successful in sealing the perforation with a success rate of usually >80%. Sealing the perforation will mean that repeated infections will no longer occur. Usually with the successful myringoplasty surgery, the hearing will also improve as the eardrum is now able to fully capture the sound energy, effectively translating this air energy to move the ear bones more effectively. However this hearing improvement is not always guaranteed. Due to the repeated infections before, there may be scarring in the middle ear cavity which prevents the ear bones from vibrating fully. Or sometimes, the ear bones have been partially or fully destroyed by the repeated toxic infection in the past. If this is so, the ear surgeon would normally repair/replace the ear bone/s either at the same time of the ear drum repair or at a second procedure, depending upon the health of the middle ear tissues.

A perforated ear drum is not a life threatening condition though it can impair one’s quality of hearing. Hence surgery is not the only option. If the ear has not had any infection or the hearing impairment is minimal, a more conservative approach to prevent water getting into the ear and to wear hearing aid, for better hearing, may suffice. This is particular true for the older patient who may not want surgery or be regarded as sufficiently fit for surgery.

For the younger and healthy patient, surgery would probably be the best treatment solution. The high success rate of eardrum repairs as well as the added quality of life years benefit gain, would be immeasurably valuable. After all, hearing well at home, at work and at play, will grant more meaningful social interactions and human relationships with our family, friends and work colleagues.


The Chinese version of this article was published in Hong Kong Economic Journal on December 23, 2013.

Ear drum perforation – Causes and Problems

Our ear and hearing is a most fantastic creation of nature. Sound waves that travel down our ear canal, vibrate our ear drum. This tightly stretched three-layered skin membrane will move. The three ear bones of our ear’s conducting system magnify this movement, and therefore the energy. This magnified energy moves the liquid of our inner cochlea, and their movement in turn, displaces sensory cells that create the electrical impulses that our brain finally understands as sound. Just think about how amazing this simple act of hearing is. Imagine how difficult it is to move the water in a cup just by gently blowing on it as you whisper!

This amplification phenomenon is made possible by our middle ear system that consists of our eardrum and ear bones. The ear drum which is made of a thin skin membrane, acts like a sail that picks up the wind energy of sound, moving the three ear bones that further amplify the energy. Nowhere else can engineers improve on this amplification system and the simplest analogy we have is the hydraulic lift pressure systems we have in our car braking system or in a car hydraulic lift of a garage!

So what happens if this system is broken as sometimes our eardrum can be broken or perforated. When this happens, less energy can be picked up, and naturally we hear less. Also our eardrum seals our sterile middle ear cavity from the bacterial outside world. So when there is a hole, however small it may be, if  irritant soapy water, or dirty contaminated fluid, enters through it into the middle ear, we end up getting a smelly ear discharge and a middle ear infection.

So what can cause us to have ruptured eardrums? Eardrums may perforate due to injury to them either from within or from the outside. Middle ear infections are the commonest infection in children; here pus is formed that bulges and painfully stretches the eardrum until in some cases, it bursts through. Usually these holes healed quickly, but sometimes if they are too large or the infection is not quick in settling, a permanent perforation may ensue. The eardrum can also be broken from the outside; this usually occurs from injury like a toothpick or ear bud, or sometimes from a slap or hit to the side of the head. Here the column of air in the ear canal suddenly acts like a bullet, breaking the eardrum from outside.

Irrespective of the cause, if there is a hole, the possibility of infection arising due to soiling from the outside is always a possibility. In addition, with the formation of a perforation in the eardrum, Mother Nature’s most efficient amplification system becomes less efficient, and the hearing is reduced.

The Chinese version of this article was published in Hong Kong Economic Journal on December 16, 2013.