Tympanic membrane, perforation of

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Tympanic membrane, perforation of 

A ruptured eardrum is a tear in the thin membrane that separates your outer ear from your inner ear. That membrane, known as the tympanic membrane, is made of tissue that resembles skin. The eardrum serves two important functions in your ear. It senses vibrating sound waves and converts the vibration into nerve impulses that convey the sound to your brain. It also protects the middle ear from bacteria as well as water and foreign objects. Normally, the middle ear is sterile. But when the eardrum is ruptured, bacteria can get into the middle ear and cause an infection known as otitis media.


Causes of a ruptured (perforated) eardrum may include:

Middle ear infection (otitis media): A middle ear infection often results in the accumulation of fluids in the middle ear. Pressure from these fluids can cause the eardrum to rupture.

Barotrauma: Barotrauma is stress exerted on the eardrum when the air pressure in the middle ear and the air pressure in the environment are out of balance. If the pressure is severe, the eardrum can rupture. Barotrauma is most often caused by air pressure changes associated with air travel.

Other events that can cause sudden changes in pressure, and possibly a ruptured eardrum, include scuba diving and a direct blow to the ear, such as the impact of an automobile air bag.

Loud sounds or blasts (acoustic trauma): A loud sound or blast, as from an explosion or gunshot, essentially an overpowering sound wave, can rarely cause a tear in the eardrum.

Foreign objects in your ear: Small objects, such as a cotton swab or hairpin, can puncture or tear the eardrum.

Severe head trauma: Severe injury, such as a skull base fracture, may cause the dislocation of or damage to middle and inner ear structures, including the eardrum.


The primary symptom of a TM perforation, or eardrum perforation, is pain. Some individuals experience severe pain. The intensity of the pain can increase or decrease and could remain steady all day long.

Some individuals don't experience any symptoms of a tympanic membrane perforation. Others feel like something just isn't right with their ear and experience general discomfort pushing them to see their doctor.

When blowing their nose, some individuals hear air coming from their ear. When you blow your nose forcefully, it causes air to move up into your middle ear, filling the space. In normal circumstances, this causes your eardrum to balloon outward. If you have a hole in your eardrum, however, air rushes out. Other people can even hear the sound sometimes if it’s loud enough.

Other symptoms of a tympanic membrane perforation include:

  • Ear buzzing or noise
  • Sudden sharp pain in your ear
  • Sudden decrease of pain in your ear
  • Dizziness or facial weakness
  • Episodic ear infections
  • Partial or complete hearing loss in the affected ear


An ENT (ear, nose and throat specialist) may identify holes or tears in the eardrum by using various methods:

  • Otoscope (auriscope): A lighted instrument used to view the ear canal
  • Audiology exam: A test that measures hearing and eardrum mobility

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