A perforated eardrum (tympanic membrane perforation) is a hole or tear in the thin membrane that separates the ear canal from the middle ear. It can cause hearing loss, ear discharge, and repeated infections. At Central Sydney ENT, our otology-trained surgeons assess perforations across seven Sydney locations and offer both non-surgical monitoring and microsurgical repair to restore hearing and protect middle ear health.
The tympanic membrane is a delicate, oval-shaped tissue approximately 8 to 10 millimetres in diameter. It serves two critical functions: transmitting sound vibrations to the ossicles (the three tiny hearing bones) in the middle ear, and acting as a barrier that protects the middle ear space from water, bacteria, and debris entering through the ear canal.
When this membrane develops a hole or tear, sound transmission is disrupted and the protective barrier is compromised. Perforations can range from a tiny pinhole to a large defect involving most of the eardrum surface. The size and location of the perforation influence both the degree of hearing loss and the likelihood of spontaneous healing.
Perforations in the posterior (back) portion of the eardrum tend to cause more significant hearing loss than anterior (front) perforations, because the posterior quadrant plays a greater role in transmitting vibrations to the ossicular chain. Marginal perforations, where the hole extends to the edge of the eardrum, carry a higher risk of cholesteatoma formation and typically require surgical repair.
The symptoms you experience depend on the size and cause of the perforation. Common signs include:
Some small perforations cause minimal symptoms and are discovered incidentally during a routine ear examination. If you experience sudden hearing loss, persistent ear discharge, or severe ear pain after trauma, you should see an ENT specialist promptly.
Eardrum perforations result from several mechanisms:
Acute otitis media (middle ear infection) is the most common cause of eardrum perforation, particularly in children. Pressure from infected fluid building up behind the eardrum can cause it to rupture. While this often relieves pain and the perforation usually heals spontaneously, recurrent infections can lead to a chronic perforation that does not close on its own.
Direct trauma to the ear can tear the eardrum. Common causes include inserting objects into the ear canal (cotton buds, hairpins), a slap or blow to the ear, skull fractures involving the temporal bone, and exposure to sudden loud blasts (explosion injuries). Traumatic perforations tend to have clean edges and a reasonable chance of healing without surgery.
Rapid changes in air or water pressure can rupture the eardrum. This occurs during activities such as scuba diving, flying with a blocked nose or upper respiratory infection, or hyperbaric oxygen therapy. Individuals with eustachian tube dysfunction are at increased risk of barotrauma-related perforation.
Ventilation tubes (grommets) placed for recurrent middle ear infections or glue ear usually extrude naturally, and the eardrum heals behind them. In approximately 1 to 3 per cent of cases, a persistent perforation remains after the grommet falls out, requiring later surgical repair.
Chronic suppurative otitis media, longstanding infection and inflammation of the middle ear, can erode the eardrum over time, creating a large or permanent perforation. This is often accompanied by granulation tissue, tympanosclerosis (calcification of the eardrum), or cholesteatoma.
Your ENT specialist at Central Sydney ENT will use several methods to assess a perforated eardrum and determine the best management plan:
Direct visual examination of the ear canal and eardrum using an otoscope or rigid endoscope. This reveals the size, location, and margins of the perforation, and identifies any associated pathology such as cholesteatoma, middle ear polyps, or granulation tissue. High-definition endoscopic images allow your surgeon to document the perforation precisely and track changes over time.
A pure tone audiogram measures hearing thresholds across different frequencies. A perforated eardrum typically produces a conductive hearing loss, where bone conduction thresholds are normal but air conduction thresholds are elevated. The size of the air-bone gap helps quantify the impact of the perforation on hearing and guides surgical decision-making.
This test measures the compliance (movement) of the eardrum in response to changes in air pressure. A perforation produces a characteristic flat trace (Type B tympanogram) with a large ear canal volume, confirming the defect. Tympanometry also helps identify concurrent eustachian tube dysfunction.
Cross-sectional imaging is not required for all perforations but is ordered when your surgeon suspects associated middle ear disease such as cholesteatoma, ossicular erosion, or mastoid pathology. CT provides detailed views of the middle ear structures and mastoid air cells, helping plan any surgical approach.
Treatment depends on the cause, size, and duration of the perforation, as well as whether active infection or other middle ear pathology is present. Dr Sam Hwang, Dr Philip Yeung, and Dr Alexander Zhang manage perforated eardrums across the Central Sydney ENT network using evidence-based approaches.
Small, acute perforations, particularly those caused by trauma or a single episode of otitis media, often heal spontaneously within six to twelve weeks. During this period, the key management priority is keeping the ear dry. You should avoid swimming, use a cotton ball coated with petroleum jelly during showering, and avoid inserting anything into the ear canal. Antibiotic ear drops may be prescribed if there is active discharge or signs of infection. Your surgeon will review the ear at four to six week intervals to monitor healing.
For small perforations that have not healed spontaneously, an in-office paper patch procedure may be attempted. The edges of the perforation are gently freshened using a fine instrument or chemical cautery, and a small paper or Gelfilm patch is placed over the hole to act as a scaffold for the eardrum to grow across. This outpatient procedure is performed under local anaesthesia and takes approximately 15 to 20 minutes. It is most effective for small, dry, central perforations and avoids the need for a formal operation.
Myringoplasty is the standard surgical procedure for repairing a perforated eardrum when conservative management has not succeeded. It is performed under general anaesthesia as a day procedure. The surgeon harvests a thin graft, most commonly temporalis fascia (tissue from above the ear) or tragal perichondrium (from the small cartilage flap at the front of the ear), and places it under or over the remaining eardrum to close the perforation.
The procedure can be performed through the ear canal (transcanal approach, often using an endoscope) or through a small incision behind the ear (postauricular approach), depending on the size and position of the perforation. Endoscopic techniques offer the advantage of no external incision and excellent visualisation of the middle ear. The ear canal is then packed with dissolving foam or ribbon gauze to support the graft during healing.
Success rates for myringoplasty are high, with graft take rates of 85 to 95 per cent in experienced hands. Most patients notice improvement in hearing within four to eight weeks as the packing dissolves and the graft heals into position.
When a perforation is associated with damage to the ossicular chain (the malleus, incus, and stapes bones), chronic middle ear disease, or cholesteatoma, a more extensive procedure called tympanoplasty is required. This combines eardrum repair with exploration and reconstruction of the middle ear structures. Ossicular reconstruction may involve repositioning the existing bones or using a prosthesis (titanium or hydroxyapatite) to bridge any gap in the hearing chain.
In cases involving cholesteatoma or extensive chronic ear disease, tympanoplasty may be combined with mastoidectomy: surgical clearance of disease from the mastoid bone behind the ear. Your surgeon will discuss the expected outcomes, including the likelihood of hearing improvement, before proceeding.
Understanding what to expect after myringoplasty or tympanoplasty helps ensure a smooth recovery:
Most patients return to desk-based work within five to seven days after myringoplasty. Physically demanding work may require two to three weeks off. Flying should be avoided for at least six weeks, and swimming until your surgeon confirms the eardrum has fully healed.
While not all perforations are preventable, the following measures reduce your risk:
You should seek specialist assessment for a perforated eardrum if:
Central Sydney ENT provides specialist otology services at seven locations across Sydney, including Burwood, Campbelltown, Gregory Hills, Ultimo, Drummoyne, Hunters Hill, and Miranda, to ensure timely access to expert assessment and surgical care.
Many small traumatic perforations heal spontaneously within two to three months. Your ENT specialist will monitor healing with regular examinations. If the perforation has not closed after three months, or if it is large, surgical repair (myringoplasty) is usually recommended to restore hearing and protect the middle ear from infection.
Myringoplasty is a surgical procedure to repair only the eardrum, typically using a tissue graft from behind the ear or from the tragal cartilage. Tympanoplasty is a more extensive operation that repairs the eardrum and also addresses disease or damage within the middle ear, including reconstruction of the ossicular chain (tiny hearing bones) if needed.
Most patients return to desk-based work within one to two weeks after myringoplasty. The ear canal packing is typically removed at a follow-up appointment two to three weeks after surgery. Full healing of the graft takes approximately six to eight weeks, during which you must keep water out of the ear and avoid nose-blowing, flying, and heavy lifting.
An untreated perforation leaves the middle ear exposed to water and bacteria, increasing the risk of recurrent ear infections and chronic ear discharge. Over time, persistent infection can damage the ossicles (hearing bones), leading to progressive conductive hearing loss. In rare cases, cholesteatoma (abnormal skin growth) may develop through the perforation into the middle ear.
Myringoplasty has a success rate of approximately 85 to 95 per cent for closing the perforation. Most patients experience meaningful improvement in hearing after successful repair. The Central Sydney ENT surgeons perform eardrum surgery regularly across seven Sydney locations, using microsurgical and endoscopic techniques to achieve optimal outcomes.
Contact Central Sydney ENT to arrange an appointment with one of our otology-trained surgeons.
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