What happens if a perforated eardrum is left untreated?
Nov 27, 2025
Source: Cainiu Health
Dr. Lu Cheng
Introduction
In general, tympanic membrane perforation—an ear condition resulting from compromised integrity of the eardrum—can lead to a series of ear problems if left untreated, including progressive hearing loss, recurrent middle ear infections, development of cholesteatoma, worsening tinnitus, and disruption of daily life. The difficulty of treating tympanic membrane perforation increases with disease duration; therefore, early intervention is recommended once diagnosed.
Generally, a perforated eardrum—defined as damage to the integrity of the tympanic membrane—can lead to a series of ear problems if left untreated. These include progressive hearing loss, recurrent middle ear infections, development of cholesteatoma, worsening tinnitus, and disruption of daily life. The details are as follows:
1. Progressive hearing loss: The eardrum is a key structure in sound conduction. When perforated, transmission of sound vibrations is impaired, initially causing only mild hearing reduction. Without treatment, the perforation may enlarge or become fibrotic at the edges, leading to progressively worsening hearing loss.
2. Recurrent middle ear infections: A perforated eardrum creates a direct connection between the external auditory canal and the middle ear cavity, allowing bacteria and contaminated water to easily enter and cause infection. Patients may experience repeated episodes of ear pain, discharge (otorrhea), and a sensation of fullness. Each infection further damages the structures of the middle ear.
3. Development of middle ear cholesteatoma: Long-standing perforations can allow epithelial tissue from the external auditory canal to migrate through the hole into the middle ear, where it accumulates and forms a cholesteatoma. This lesion slowly erodes the surrounding bone, potentially damaging critical structures such as the ossicles and facial nerve, leading to severe hearing impairment or even facial paralysis.
4. Worsening tinnitus: The perforation can irritate nerve endings in the middle and inner ear, often resulting in tinnitus—typically perceived as a persistent humming or cricket-like sound. Without treatment, the frequency and loudness of tinnitus tend to increase, becoming particularly noticeable in quiet environments and interfering with sleep and concentration.
5. Impact on daily life: Hearing loss and tinnitus can make communication difficult and cause individuals to miss important auditory cues. Recurrent infections accompanied by ear pain and discharge can disrupt sleep and emotional well-being. Some patients avoid routine activities such as swimming or washing their hair due to concerns about ear health, ultimately reducing their quality of life.
The difficulty of treating a perforated eardrum increases with disease duration; therefore, early intervention is strongly recommended once diagnosed. In daily life, it's essential to keep the external ear canal dry, prevent contaminated water from entering the ear, avoid noisy environments, refrain from inserting objects into the ear, and minimize irritation to slow disease progression.
