Signs and Symptoms of Tympanic Membrane (Eardrum) Rupture
Tympanic membrane perforation typically presents with sudden ear pain, hearing loss, bloody or purulent drainage from the ear canal, and may be accompanied by tinnitus and a sensation of aural fullness. 1, 2
Primary Clinical Manifestations
Acute Symptoms at Time of Rupture
- Sudden sharp ear pain that may subsequently decrease once the perforation occurs 2
- Bloody discharge (otorrhea) from the affected ear canal, which may appear immediately at the time of rupture 3, 2
- Hearing loss, typically conductive in nature, ranging from mild (5-40 dB) depending on perforation size 1, 2
Associated Symptoms
- Tinnitus (ringing or buzzing in the ear) 2
- Aural fullness or sensation of pressure in the ear 4, 2
- Purulent discharge if associated with infection (acute otitis media) 2
Warning Signs Requiring Urgent Evaluation
Vertigo, nausea, vomiting, or profound hearing loss suggest more serious complications that require immediate otolaryngologic consultation 2:
- Vertigo with nausea/vomiting may indicate inner ear involvement or caloric effects from fluid entering the middle ear 5
- Conductive hearing loss >30 dB suggests possible ossicular chain disruption 2
- Profound sensorineural hearing loss may signify inner ear nerve damage 2
- Facial paralysis indicates need for urgent ENT referral 1
- Continuous pain that persists or worsens warrants specialist evaluation 1
Physical Examination Findings
Otoscopic Examination
- Visible perforation of the tympanic membrane on direct visualization 2
- Blood or purulent secretions in the ear canal 2
- Location and size of the perforation should be documented, as perforations involving <80% of the drumhead typically heal spontaneously, while those >80% often persist 6
Key Examination Caveats
- Avoid irrigation in suspected or confirmed tympanic membrane perforation, as this can cause infection, pain, ototoxic hearing loss, or vertigo from caloric effects 5
- Avoid pneumatic otoscopy when perforation is suspected 2
- Carefully suction blood and debris from the canal for adequate visualization 2
Common Etiologies to Consider
The clinical presentation may vary based on the cause of perforation 1, 2:
- Trauma (direct injury, blast injury, barotrauma)
- Acute otitis media with spontaneous rupture
- Chronic middle ear infection
- Iatrogenic (following procedures or excessive Valsalva maneuvers) 3
Clinical Pearls
- Most small traumatic perforations (<80% surface area) heal spontaneously within weeks to months, with approximately one month needed for every 10% loss of drumhead surface area 6
- Perforations do not protect the inner ear from damage in blast injuries or other trauma 6
- The affected ear should be kept dry to prevent secondary infection 1, 2
- Hearing loss is typically conductive but does not usually exceed mild levels unless complications are present 1, 2