Hearing management

Updated 07 December 2017

3 causes of a burst eardrum

A burst eardrum is excruciatingly painful and should also be treated as a medical emergency.

Our ears perform two important tasks: they translate the sounds around us into information that our brains can understand, and they help our bodies with balance − which is why it’s so important to keep your ears healthy and safe. 

But when should we worry that we may have a burst eardrum? And what are the signs of a possible burst eardrum?

Dr Anna Hall, a GP practicing in Cape Town, explains: “A burst eardrum is suspected when there is a discharge of fluid, blood or pus from the ear, or sudden hearing loss associated with head trauma.

“It’s a fairly uncommon condition but does require immediate attention and referral to an ENT. If you suspect a burst eardrum, don’t put any drops into your ear and consult a doctor immediately for help.”

Three causes of a burst eardrum: 

1. Infection

An ear infection is a common cause of a burst eardrum. Fluid will build up behind the eardrum and the pressure will increase, causing the tympanic membrane to break or rupture. This is a common cause of burst eardrums in children. 

Heidi Taylor, an audiologist at the Ear Institute in Pietermaritzburg, says: “It’s likely that the pain and discomfort from an ear infection would result in seeking medical help prior to the eardrum getting to the stage of the burst.”

She adds that you may need to have a hearing test done as sometimes the perforation can be so small your doctor may not see it during an otoscopic examination. However, middle-ear pressure tests and pure tone audiometry will indicate the presence of a perforation and the associated degree of hearing loss.  

ear infection, child, doctor, ears


2. Pressure changes

A change in air pressure can also cause a burst eardrum – it usually happens when the pressure outside the ear is vastly different compared to the inside of the ear. Scuba diving, shock waves, flying in an aeroplane and driving at high altitudes are some of the ways you may be exposed to extreme air pressure changes. 

scubadiving, swimming, water, ears, pressure


3. Injury or trauma

If you get hit on the ear, sustain any injuries playing sports, fall on your ear or suffer injury as a result of a car accident, you are at risk of suffering a burst eardrum. Any trauma to the ear or head can cause an eardrum to rupture.

Be careful of putting any kind of object – fingernail, pen, earbud – too far into your ear, as this can also cause damage. 

Damage caused by extremely loud noises (louder than 85 decibels, a gunshot or explosion for example) can cause a burst eardrum, but this is not as common as one might think. 

ear bud, ears, hearing loss


When to see your doctor

If you think you have a ruptured eardrum (symptoms include pain that subsides quickly, hearing loss, tinnitus, vertigo, nausea or vomiting, or discharge from your ear), see your doctor immediately. Prompt treatment will help preserve your hearing. 

A GP will do an otoscopic examination (looking inside your ear with a small torch). Many perforations are clearly visible but there are some that may be so small that they go unnoticed by the doctor.  An ENT specialist can do the otoscopic examination and a middle ear pressure test. An audiologist can perform all these tests, and also conduct a pure tone air and bone conduction hearing test to determine the degree of hearing loss caused by the perforation.

Treatment options

“Many perforations are small enough to heal themselves over time,” says Heidi. “However, some require closure by a surgical technique known as tympanoplasty (entire or partial replacement of the eardrum using tissue grafts).”  

Most perforations are caused by a middle-ear infection that may go unnoticed or untreated. This often affects children, so parents should ask the doctor to examine their children’s ears when any form of upper respiratory tract infection occurs, or tonsillitis and the like are treated.

“Children often have quite high pain thresholds and ear infections fly under the radar,” says Heidi.

Read more: 

Earbuds linked to ruptured eardrums

Ear canal infection

Middle ear infection


Ask the Expert

Hearing Expert

Minette Lister graduated with a Bachelor of Communication Pathology (Audiology) from the University of KwaZulu-Natal, Westville in 2015. Thereafter, she completed her compulsory year of community service at Phoenix Assessment and Therapy Centre in Durban. In 2017, Minette started working for Thompson and Hoffman Audiology Inc. She is passionate about working with children and adults to diagnose and manage hearing loss using state of the art technology. Minette offers hearing screening programmes for newborn and high-risk babies, as well as school-aged children, in order to decrease the incidence of late or unidentified hearing loss.

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