Hearing with a Ruptured Tympanic Membrane
Yes, you can still hear from an ear with a ruptured tympanic membrane, but hearing will be reduced, typically causing a mild to moderate conductive hearing loss that is most pronounced at low frequencies. 1
Mechanism of Hearing Loss
The hearing impairment occurs because the perforation reduces the sound-pressure difference across the tympanic membrane, which is the dominant mechanism of hearing loss rather than direct acoustic stimulation of the oval and round windows. 1
The degree of hearing loss depends on three key factors:
- Perforation size: Larger perforations cause greater hearing loss, with maximum loss (51.56 ± 5.1 dB) occurring when all four quadrants are involved 2
- Frequency affected: Loss is largest at low frequencies and increases as perforation size increases 1
- Location: Perforations involving the posterior half of the tympanic membrane show greater hearing loss than those involving the anterior or inferior half 2
Expected Hearing Loss Severity
Most tympanic membrane perforations cause only mild conductive hearing loss (typically less than 30 dB), with patients experiencing aural fullness and mild tinnitus. 3
- Single quadrant perforations result in less hearing loss than multi-quadrant involvement 2
- In combat blast injuries with an average perforation of 35-41% surface area, the most common audiogram abnormality was mild high-frequency hearing loss, and only 5% of patients ultimately required hearing aids 4
- Conductive hearing loss greater than 30 dB suggests possible ossicular chain disruption requiring further evaluation 3
Clinical Implications
The middle ear air-space volume influences the degree of loss—larger volumes result in smaller hearing deficits. 1 This explains why hearing loss from perforations alone is generally not severe enough to prevent functional hearing.
Warning Signs Requiring Urgent Evaluation
- Profound sensorineural hearing loss may signify inner ear nerve damage and requires immediate otolaryngologic referral 3
- Vertigo, nausea, and vomiting with conductive loss exceeding 30 dB suggests ossicular chain disruption 3
Most patients with tympanic membrane perforations remain symptomatic, with 77% reporting diminished hearing and 50% experiencing tinnitus, but long-term severe hearing loss is uncommon. 4