Perforation of the tympanic membrane is a common problem with many different causes.
- Otitis media. Infection of the middle ear can lead to perforation. The space in the middle ear which is usually filled with air becomes full of fluid which becomes secondarily infected. The pus increases in volume, stretching then sometimes perforating the ear drum. Severe pain followed by relief and a gush of pus and blood are cardinal signs.
- Pressure. Rapid changes in pressure such as from a bomb blast, aeroplane travel and scuba diving can all cause a burst ear drum. It is more likely to happen in someone with Eustachian Tube Dysfunction. This prevents the middle ear pressure equalising with the outside world. A pressure gradient appears across the drum. Going up and down a mountain the ear usually has time to adjust to the change in pressure. If there is a blast wave, for example from a truck tyre exploding or a bomb the ear doesn't have time to compensate and the eardrum may rupture.
- Surgical. A surgical myringotomy may be performed to ventilate the middle ear space in order to prevent recurrent ear infections. A tiny hole is made with a scalpel and a tiny bobbin called a grommet is inserted to hold the hole open and stop it healing closed. Ear plugs may be recommended by the ENT surgeon to keep water out of the ears.
Dr Toby Bateson for zenplugs.com