What Causes a Ruptured Eardrum?

Reviewed by Dr. Porter on December 3, 2021

Every year about 150,000 Americans undergo a surgical procedure called tympanoplasty, or a ruptured eardrum. We don’t know exactly how many people have had ruptured eardrums, but one survey found that 3 percent of children with chronic ear infections will develop a ruptured eardrum at some time in their childhood. The percentage is even higher among Native American children. The number of surgeries suggests that about 2 percent of adults suffer a ruptured eardrum at some point in their lives.

Ruptured Eardrum Is Sometimes a Traumatic Condition

Probably just about everyone has heard the term “ear-splitting.” Extremely loud noises from gunshots or explosions can generate so much energy inside the ear canal that they overcome the best efforts of tiny muscles around the bones in the ear to block the sound. It really is possible to split open the eardrum with extremely loud noise.

But this cause of ruptured eardrums is rare.

Eardrum Rupture Is More Likely to Come on Slowly

Far more cases of ruptured eardrums are brought on by middle ear infection. Infection in the ear canal has two simultaneous effects. One is inflammation. The inflammation caused by the body’s response to infection places pressure on the eardrum. The other is ischemia, or lack of blood flow to the eardrum. Inflammation also puts pressure on the blood vessels that carry oxygen, nutrients, and fluid to the eardrum. It becomes dehydrated and more susceptible to damage.

Preventing this cause of ruptured eardrums isn’t as simple as prescribing more and more antibiotics. Many ear infections are caused by viruses, which aren’t affected by antibiotics. And when bacterial infections are treated with the same antibiotics every time they come back, a few bacteria develop antibiotic resistance just by chance. These bacteria take over and cause serious infections that more antibiotics won’t stop.

Antibiotic treatment is something that has to be managed by your ENT or primary care physician. There is a balance between too much antibiotic therapy and not enough. Middle ear infections that aren’t treated can cause serious infections in the brain and blood clots in some of the blood vessels that serve the ears.

It’s rare for a ruptured eardrum to be caused directly by infection. It is more often a combination of infection, inflammation, ischemia, and some triggering event, like those we will discuss in a moment. However, a mold called Aspergillus niger can cause direct damage to the eardrum.

ringing in your ears

Uncommon Causes of Ruptured Eardrum

Ruptured eardrum due to “ear-splitting” noise is rare. So are these causes of eardrum rupture:

  • Traumatic blows to the ear, such as getting punched in the ear, falling off snow skis or water skis on your ear, or having a bullet whizz past your ear.
  • Exposure to extreme changes in atmospheric pressure from an explosion or staying in a shelter during a tornado that passes directly overhead.
  • Coming up too soon from scuba diving or free diving, especially when the eardrum has been previously weakened by disease.

A ruptured eardrum can also result from ill-advised ear cleaning practices. Sticking a Q tip swab into your ear too far can rupture your eardrum. So can attempting to remove ear wax with hot water or a Water Pic. Sticking a pencil, a bobby pin, or a needle into your ear is highly likely to rupture your eardrum.

What Are the Symptoms of Ruptured Eardrum?

Some of the following are the more serious, acute symptoms of ruptured eardrum. You should get to the ER or make an appointment with an ENT immediately if you experience:

  • Muffled hearing
  • Intense pain in your ear
  • Fluid oozing from your ear
  • Bleeding from your ear
  • Dizziness
  • Nausea
  • Ringing in your ears

Many people who have ruptured eardrums, however, never notice any symptoms at all. They just have a sense that they aren’t hearing as well as they should be. Many people who have repeated ear infections they pick up while swimming can’t really point to one event that caused their ruptured eardrum. They will only know that they have had a ruptured eardrum when they get a complete exam from their audiologist.

The hearing specialists at Harbor Audiology can provide you with the hearing care you need to achieve the best hearing possible. We can help you choose the best of the most advanced hearing aids.

Harbor Audiology is experienced in filing for VA benefits, and we work with all major insurance plans. We are open most evenings and Saturdays. Harbor Audiology has offices in Tacoma, Gig Harbor, Silverdale, Sequim, Port Angeles, and Federal Way. Request your appointment online today!

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