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

Dr Kara Hoffman graduated from UCT in 2004, thereafter she completed her year of community service in Durban. In 2010 she completed her Masters Degree in Paediatric Aural Rehabilitation from UKZN. In 2016, she became a Doctor of Audiology through the University of Arizona (ATSU). Dr Hoffman and her partner Lauren Thompson opened a fully diagnostic audiology practice called Thompson & Hoffman Audiology Inc. In 2011 with world-class technology and equipment to be able to offer the broad public all hearing-related services including hearing testing for adults and babies, vestibular (balance) assessments and rehabilitation, industrial audiology, hearing devices, central auditory processing assessments for school-aged children, school screening, neonatal hearing screening programmes at Alberlito and Parklands Hospital, cochlear implants and other implantable devices, medicolegal assessments and advanced electroacoustic assessments of hearing. Thompson and Hoffman Audiology Inc. are based at Alberlito Hospital in Ballito, St Augustines Hospital in Durban and at 345 Essenwood Road, Musgrave. The practices are all wheelchair friendly. There are three audiologists that practice from Thompson & Hoffman – including Dr Kara Hoffman, Lauren Thompson & Minette Lister. The practice boasts professional, highly qualified, and extensive diagnostic services where all your hearing healthcare needs can be met. The additional licensing in vestibular assessment and rehabilitation, paediatric rehabilitation and cochlear implantation places this practice in one of the top specialist audiological positions in South Africa, with a wealth of experience in all clinical areas of audiology and is a very well respected and sought-after practice.

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