About Eardrums

What is a perforation (or hole) in the eardrum?

The eardrum is a thin sheet of tissue that vibrates when a sound wave reaches it. Different mechanisms can cause a hole to occur in the thin eardrum. For example, an ear infection can cause an accumulation of pus behind the eardrum. As the pus builds up, the eardrum stretches like a water balloon, which can give the child significant ear pain. In some children, the pressure is sufficient that the eardrum "bursts," causing a hole in the eardrum, with a paradoxical relief of pain. This type of hole in the eardrum usually heals spontaneously, within a few days.

Mechanical trauma can also cause a hole in the eardrum. For example, sometimes the force of pressure from a dive into water by a young swimmer, can rupture the drum. Often the rupture will heal but occasionally, the perforation persists.

The most common reason for a hole in the eardrum is the result of a surgical procedure. This intentionally created perforation, allows ventilation to occur in the middle ear. Children who have had many ear infections and a subsequent problem of fluid remaining in the middle ear, usually can be helped by the placement of a ventilation tube. An incision is made in the eardrum and a hollow tube is placed in the eardrum to maintain the opening. The opening usually persists for a few months or years until the child has outgrown the problem. Usually the eardrum extrudes the tube on its own, and the perforation closes. Occasionally the perforation persists and needs further treatment.

Is a hole in the eardrum a "bad" thing?

A perforation created for the treatment of the consequences of ear infections, is an ally to your child's ear for the short run. However, after a period of time (usually years) if a hole in the eardrum has not closed spontaneously, and if the child is no longer having ear infections, the perforation presents some nuisance issues.

For example, water should not get into the ear because it can enter the eardrum through the hole and inoculate the ear with bacteria thus causing an ear infection. Also, the perforation must be checked periodically by a physician to make sure that the ear is not developing more chronic ear infections or more significant disease, such as cholesteatoma (see section below) or an ear polyp or a larger perforation.

Can a hole in the eardrum be closed?

When the hole is probably no longer necessary, various techniques can be utilized to close the hole.

How does one close a hole in the eardrum?

Surgery is required to close a hole in the eardrum. Different techniques are available to the surgeon. If the hole is small, an operation can be done through the ear canal to the eardrum to place the patient's own tissue into the hole like one would place a cork into a bottle. Dr. Eavey has developed this technique which is now used by individuals in other parts of the world, such as Brazil. The procedure has even been used in remote areas of Australia by the Royal Flying Doctors, who assist the Aboriginal population.

The procedure described above is an outpatient procedure The patient is relatively comfortable during the process since no packing is required in either the middle ear or the ear canal. If a perforation is larger, it may be necessary to make an incision behind the ear. Cartilage and other tissues such as fascia (a thin type of tissue that coats muscles and is readily available) can be utilized to make the repair. Sometimes an eardrum operation (tympanoplasty) is combined with a mastoidectomy when more serious ear disease is present.(See below under cholesteatoma.)

Does the eardrum operation always work?

The procedure works 80-90% of the time. If the surgery is for closing a hole in the eardrum, usually hearing is spared or improved. If more serious disease exists in the middle ear, or there is a problem in the inner ear, hearing might not be normal even with the surgery.