What should I do if my eardrum is perforated?

There are numerous causes of tympanic membrane (eardrum) perforation, but the most common cause encountered in daily clinical practice is trauma-induced perforation. Examples include being slapped across the ear or having a foreign object accidentally inserted into the ear canal—both of which may result in eardrum rupture. So, what should we do first in such cases?

First and foremost, keep the external auditory canal dry. Under no circumstances should water enter the ear, and no medications should be instilled into the ear canal. Oral anti-inflammatory agents or antibiotics may be taken to prevent infection of the external auditory canal; however, topical ear medications must be strictly avoided. As long as the external auditory canal remains dry and infection-free, many small perforations will heal spontaneously.

However, larger perforations may require secondary surgical intervention—namely, tympanic membrane repair (myringoplasty)—at a hospital setting. This addresses the first category: traumatic tympanic membrane perforation.

Secondly, for perforations caused by otitis media—particularly those associated with purulent discharge—the primary focus must be on treating the underlying otitis media. With prompt and appropriate treatment, most cases of acute otitis media resolve completely, and small perforations often heal spontaneously. In contrast, large perforations or chronic perforations resulting from recurrent otitis media may fail to heal and thus necessitate surgical repair.

Thirdly, although rare, tympanic membrane perforations may also arise from tumors or other pathological conditions. In such instances, timely medical evaluation at a hospital is essential to identify and address the underlying etiology.