Healing Time for Ruptured Eardrums
Most traumatic tympanic membrane perforations heal spontaneously within 2-8 weeks, with the majority closing completely within 2 months, though some may take up to 3 months for full resolution. 1, 2
Expected Timeline for Spontaneous Healing
- Small to medium perforations typically heal within 2-4 weeks on average 1
- Larger perforations may require 6-8 weeks or longer, with healing time significantly dependent on perforation size 1
- Complete resolution of most traumatic perforations occurs by 6 weeks postinjury, as documented in emergency department follow-up studies 2
- The overall spontaneous healing rate for traumatic perforations is approximately 93-95% when allowed to heal naturally over 12 months 1, 2
Factors Affecting Healing Time
Perforation characteristics significantly influence healing duration:
- Dry perforations (without discharge) take an average of 28 days to heal 1
- Perforations with serosanguinous discharge heal faster at approximately 16 days on average, though the sequence of tissue repair differs 1
- Edge configuration (inverted, everted, or flat) does not significantly affect healing rate or time 1
- Pre-existing tympanosclerosis is the most prominent cause of healing failure and should raise concern for non-resolution 1
Mechanism-Specific Healing Patterns
Blast injuries and thermal/caustic trauma have poorer prognosis:
- Blunt and penetrating trauma perforations generally heal spontaneously with good outcomes 3
- Blast trauma perforations are less likely to heal spontaneously compared to other mechanisms 3
- Thermal or caustic injuries to the tympanic membrane have reduced spontaneous healing rates 3
When Surgical Intervention Becomes Necessary
Perforations persisting beyond 3-6 months warrant surgical consideration:
- Tympanoplasty should be considered for perforations lasting 6 months or longer after injury 4, 3
- Small ruptures should be observed for spontaneous healing, while subtotal and total ruptures that fail to heal in 3 months are candidates for surgery 4
- Surgical closure rates with temporal fascia, perichondrium, or heterograft are comparable at 89-92% success 4
Critical Monitoring Requirements
Biannual follow-up for minimum 2 years is essential:
- Any traumatic tympanic membrane perforation carries risk of cholesteatoma formation, requiring biannual otoscopic examination for at least 2 years 3
- Hearing assessment should be performed during follow-up to document recovery of conductive hearing loss 1
- Patients who do not show signs of healing by 8-12 weeks should be referred to otolaryngology for surgical evaluation 1, 4