Medical expert of the article
New publications
Damage to the eardrum
Last reviewed: 05.07.2025
All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
Causes of eardrum damage
Household mechanical injuries occur when the eardrum is directly affected by an object inserted into the external auditory canal to clear it of earwax or accidentally inserted into it, when the auricle is struck with an open palm (a sharp increase in pressure in the external auditory canal), or when sneezing hard with pinched nostrils (a sharp increase in pressure in the tympanic cavity, eardrum), or when kissing the ear (the occurrence of negative pressure in the external auditory canal), leading to a rupture of the eardrum. Mechanical damage to the eardrum can occur when falling on the ear, with deeper injuries to it, accompanied by a violation of the integrity of the tympanic cavity and the pyramid of the temporal bone, in cases where the fracture line passes through the tympanic ring. Household injuries may include thermal and chemical burns resulting from an accident. These burns are usually accompanied by damage to the auricle.
Industrial damage to the eardrum is divided into barometric, caused by a sharp change in air pressure (in caissons, pressure chambers, in diving suits, during industrial explosions, etc.), thermal (in the metallurgical industry, in forging, pottery, etc.) and chemical, when caustic liquids enter the external auditory canal and the auricle.
Damage to the eardrum of a military nature is divided into gunshot (bullet, shrapnel) and barometric or detonation (according to V.I. Voyachek), caused by mine-explosive action.
[ 5 ]
Pathogenesis and pathological anatomy
When the barometric pressure in the external auditory canal or tympanic cavity increases, the eardrum stretches, deforming its structures, and depending on the force of pressure, this deformation can occur at the cellular level, as well as at the microfibrous and microvascular level. In such injuries, only individual elements and layers of the eardrum can be affected without total disruption of the integrity of all its layers. With the weakest impacts, injection of vessels in the relaxed part and along the handle of the malleus can be observed; with a stronger injury associated with rupture of the vessels of the eardrum, hemorrhages occur in it, and with significant barometric impact - a complete rupture of the eardrum, which, due to the elasticity of the middle layer, stretching the edges of the wound, is visualized as an opening with uneven (torn) edges covered with a small amount of blood. A similar, but pathologically more pronounced picture is observed in industrial and detonation-explosive injuries of the eardrum. Gunshot wounds are characterized by significant destruction of not only the eardrum, but also the surrounding tissues.
All types of mechanical trauma to the eardrum with a violation of its integrity are considered infected, which creates the risk of secondary infection with severe clinical consequences (acute purulent otitis and mastoiditis, labyrinthitis, sinus thrombosis, etc.).
Burns of the eardrum by acids and caustic alkalis, as a rule, lead to its complete destruction, often to the destruction of the structures of the middle ear and the penetration of the caustic substance through the vestibular and tympanic windows into the labyrinth with dire consequences for auditory and vestibular functions.
[ 6 ]
Symptoms of a damaged eardrum
Trauma to the eardrum is accompanied by the appearance of sharp pain, ear congestion, hearing loss and tinnitus. During otoscopy, various variants of traumatic damage to the eardrum can be observed - from a slight injection of blood vessels along the handle of the malleus to massive hemorrhages, fissure ruptures, scalloped perforations to subtotal defects of the eardrum. In the presence of a perforation of the eardrum, patients sometimes report that air comes out of the damaged ear when blowing their nose (Valsalva's test). This fact indicates the presence of a perforation of the eardrum, however, this test is not recommended due to the possibility of infection being carried into the middle ear from the nasal cavity through the auditory tube and the damaged eardrum. The further clinical course is determined by the degree of damage to the integrity of the eardrum and the possible addition of a secondary infection.
In the case of small slit perforations, in the vast majority of cases their edges stick together and spontaneous healing of the injured eardrum occurs, after which either no traces of perforation remain on it, or scars of various sizes are formed, which over time are saturated with calcium salts, defined as white formations, "built into" the thickness of the eardrum. In such cases, the hearing function remains normal. In case of significant ruptures with divergence of the edges of the wound, massive scarring of the eardrum occurs with the formation of coarse calcifications (the so-called adhesive otitis) or persistent single perforation. In these cases, signs of conductive hearing loss of varying degrees are revealed.
In case of extensive trauma to the eardrum, the auditory ossicles, their joints and internal muscles of the tympanic cavity may be involved in the traumatic process. The most common phenomenon in this case is a rupture of the malleus-anvil or incudostapedial joint, as well as a fracture of the legs of the stapes and a subluxation or fracture of its base. When the chain of auditory ossicles is broken, a sudden, almost complete conductive hearing loss occurs, and when the base of the stapes is damaged, a sharp noise in the ear occurs, the hearing loss becomes mixed, vestibular dysfunction and perilymph leakage may be observed.
[ 7 ]
Where does it hurt?
What do need to examine?
How to examine?
Who to contact?
Treatment and prognosis of eardrum damage
In case of uncomplicated damage to the eardrum, treatment is reduced to a minimum. Any active manipulations in the external auditory canal and on the eardrum, the introduction of drops and ear rinsing are prohibited. If there are blood clots in the external auditory canal, they are carefully removed using dry sterile cotton wool, the walls of the ear canal are treated with moistened ethyl alcohol and a wrung-out cotton pad, and dry sterile turundas are loosely placed in it. If complications arise in the form of purulent inflammation of the middle ear, treatment is carried out corresponding to acute purulent otitis media. If damage to the structures of the tympanic cavity is suspected, appropriate treatment is carried out until the acute symptoms subside and the damage to the eardrum is eliminated. Subsequently, the victim is examined for the state of the auditory and vestibular functions and the nature of further treatment is determined.
The prognosis depends on the extent and depth of damage to the eardrum and middle ear structures, and is determined in relation to secondary infection and auditory and vestibular functions. In most cases, in the absence of the above complications, the prognosis is favorable. The addition of secondary infection or the presence of dissociation of the auditory ossicular chain makes the prognosis questionable and depends on further special treatment.