What are the symptoms of spontaneous tympanic membrane rupture?

Symptoms of Spontaneous Tympanic Membrane Rupture

The primary symptoms of spontaneous tympanic membrane rupture include hearing loss, ear fullness, mild tinnitus, and occasionally ear pain, with possible ear discharge if infection is present.

Primary Symptoms

• Hearing loss - typically mild conductive hearing loss is the most common symptom of tympanic membrane perforation 1
• Aural fullness - sensation of pressure or fullness in the affected ear 1
• Mild tinnitus - ringing or buzzing sounds in the ear 1
• Ear discharge - may occur if the perforation is associated with infection 2, 1
• Ear pain - not common with simple perforation but may indicate infection or other pathology 2

Associated Symptoms

• Vertigo, nausea, and vomiting - when present, suggest possible disruption of the ossicular chain or inner ear involvement 1
• Significant hearing loss (>30 dB conductive loss) - suggests ossicular chain disruption rather than simple perforation 1
• Profound sensorineural hearing loss - may indicate inner ear or nerve damage 1

Symptom Variations Based on Cause

Traumatic Perforation

• Sudden onset of symptoms following trauma 3
• May have history of direct injury (penetrating objects, slaps, blast injuries) 3, 4
• Pain is typically more prominent immediately after traumatic perforation 3

Infection-Related Perforation

• Often preceded by symptoms of acute otitis media (ear pain, fever) 2
• Sudden relief of pain when perforation occurs (due to pressure release) 2
• Purulent discharge is more common 2

Physical Examination Findings

• Visible perforation on otoscopic examination 2
• Location and size of perforation can be observed (affects healing prognosis) 4
• Pneumatic otoscopy should be avoided with suspected perforation as it may cause vertigo or further damage 1

Diagnostic Considerations

• Weber tuning fork test may lateralize to the affected ear (indicating conductive hearing loss) 2
• Rinne test may show bone conduction better than air conduction in the affected ear 2
• Audiometry may reveal the degree of hearing loss 1

Healing and Prognosis

• Most small perforations (78-94%) heal spontaneously within weeks to months 4, 5
• Healing rates vary inversely with patient age and perforation size 4
• Perforations in contact with the malleus have lower rates of spontaneous closure 6
• Factors that delay healing include large perforation size (≥50% of tympanic membrane), ear discharge, and inappropriate interventions like ear syringing 4

Important Cautions

• Avoid irrigation of the ear with suspected perforation as this can lead to vertigo, infection, and delayed healing 2, 4
• Keep the affected ear dry to prevent infection and promote healing 1
• If using topical medications with a perforated eardrum, use non-ototoxic preparations like ofloxacin to avoid inner ear damage 7
• Avoid pneumatic otoscopy with suspected perforation 1

When to Seek Medical Attention

• Persistent symptoms beyond 1-3 months 1, 6
• Development of vertigo, severe hearing loss, or facial weakness 1
• Signs of infection including fever, increasing pain, or purulent discharge 2
• Failure of spontaneous healing after 6 months may indicate need for surgical intervention 6