Perforated Eardrum: Symptoms, Causes and When Tympanoplasty May Help

A perforated eardrum means there is a hole or tear in the tympanic membrane, the thin membrane that separates the ear canal from the middle ear. Some perforations heal naturally. Others persist and cause repeated infections, hearing loss or difficulty getting water in the ear.

Patients may be told they have a perforation after an ear infection, trauma, grommet insertion, barotrauma from flying or diving, or previous ear surgery. The key question is whether the ear is safe, dry and hearing adequately, or whether repair should be considered.

Hampshire ENT Clinics provides consultant-led assessment for eardrum perforations, ear discharge, hearing loss and chronic ear symptoms across Hampshire and the South Coast.

Quick answer: does a perforated eardrum need surgery?

Not always. Small traumatic perforations often heal on their own. Surgery, called tympanoplasty or myringoplasty, may be considered if the perforation persists, causes recurrent infections, affects hearing, prevents swimming or allows repeated water-related ear infections.

What symptoms can a perforated eardrum cause?

Symptoms vary depending on the size, position and cause of the perforation. Some patients have mild hearing loss only. Others develop recurrent discharge, ear infections after swimming, tinnitus, discomfort or a blocked sensation.

A sudden perforation may cause pain followed by discharge or blood-stained fluid. In some cases, patients notice that pain improves once pressure is released through the eardrum.

Common causes

Common causes include acute middle ear infection, repeated infections, trauma from cotton buds or objects in the ear, pressure injury from flying or diving, previous grommets and chronic Eustachian tube dysfunction.

A perforation can also be associated with cholesteatoma or chronic middle ear disease. This is why persistent discharge or recurrent infections need careful specialist examination rather than repeated treatment without a diagnosis.

How is a perforation diagnosed?

Diagnosis is usually made by examining the ear with an otoscope, microscope or endoscope. The consultant assesses the size and position of the perforation, whether the middle ear lining is healthy, whether there is infection, and whether there are signs of cholesteatoma.

A hearing test is usually helpful. This measures whether hearing loss is conductive, sensorineural or mixed and helps decide whether surgery might improve hearing.

Can a perforated eardrum heal by itself?

Yes. Many acute traumatic perforations and infection-related perforations heal naturally, especially when the ear is kept dry and infection is controlled. Healing is less likely if the perforation has been present for a long time, is large, is associated with ongoing infection or is linked to chronic Eustachian tube dysfunction.

Your consultant may recommend a period of observation before surgery if the perforation is recent and the ear is otherwise healthy.

How should I protect the ear?

Keeping the ear dry is important. Water entering the middle ear through a perforation can trigger infection. Patients are usually advised to avoid swimming unless specifically cleared and to use appropriate precautions when showering.

Cotton buds and self-instrumentation should be avoided. Ear drops should be used only when prescribed, because the choice of drop matters when the eardrum is not intact.

What is tympanoplasty?

Tympanoplasty is an operation to repair the eardrum. The term myringoplasty is also used when the operation is focused on closing the eardrum itself. A graft is placed to close the hole and allow the eardrum to heal.

The aims are to reduce infections, create a dry ear, improve water tolerance and, in selected cases, improve hearing. If the hearing bones are damaged, additional reconstruction may be considered.

What are the risks and recovery considerations?

As with any operation, tympanoplasty has risks. These include failure of the graft to take, persistent perforation, infection, taste disturbance, tinnitus change, dizziness and hearing that does not improve as expected. Serious complications are uncommon but should be discussed during consent.

Recovery usually involves keeping the ear dry, avoiding pressure changes, avoiding heavy straining initially and attending follow-up to check healing. Flying and swimming advice should be individualised.

When to book an ENT appointment

Consider ENT review if you have a known perforation, recurrent ear discharge, hearing loss, tinnitus, infections after swimming, a perforation that has not healed, or uncertainty about whether your ear is safe for water exposure or flying.

Hampshire ENT Clinics can provide assessment, hearing testing guidance and a clear management plan for patients with perforated eardrums and chronic ear symptoms.

Frequently asked questions

Can a perforated eardrum heal naturally?

Yes. Many recent small perforations heal by themselves. Longstanding or large perforations are less likely to close without surgery.

How do I know if I have a perforated eardrum?

You may have hearing loss, discharge, tinnitus or infections after water exposure, but diagnosis requires examination of the eardrum.

Can I swim with a perforated eardrum?

Usually swimming is avoided unless your ENT specialist advises otherwise. Water entering the middle ear can trigger infection.

Can I fly with a perforated eardrum?

Many patients can fly, and pressure pain may even be less with a perforation, but advice depends on infection, symptoms and the underlying ear condition.

Are ear drops safe with a perforated eardrum?

Some drops are suitable and others may not be. Use only drops recommended by a clinician who knows the eardrum is perforated.

What is tympanoplasty?

Tympanoplasty is surgical repair of the eardrum, sometimes with reconstruction of middle ear structures if needed.

Will tympanoplasty improve hearing?

It may improve conductive hearing loss, but the main goal is often to create a safe, dry ear. Hearing benefit depends on the middle ear and hearing bones.

Can a perforation cause tinnitus?

Yes. Tinnitus can occur with hearing loss or middle ear disease associated with a perforation.

What happens if I leave a perforation untreated?

Some stable dry perforations can be observed. Others cause repeated infections, hearing problems or risk of chronic ear disease. Specialist assessment helps decide.

Can Hampshire ENT Clinics assess eardrum perforations?

Yes. We assess perforated eardrums, recurrent discharge, hearing loss and related ear problems across Hampshire.