Healing Time for Ruptured Eardrum
Most traumatic tympanic membrane perforations heal spontaneously within 2-4 weeks, with approximately 89-94% closing completely within 3 months without surgical intervention. 1, 2
Expected Healing Timeline
The healing process follows a predictable pattern based on perforation characteristics:
- Small perforations: Average closure time of 22.8 days 2
- Medium to large perforations: Average closure time of 47.3 days, though healing rates remain high at 54-92% 2
- Most perforations: 67-94% heal within the first 2-3 months 1, 3, 4
- Delayed healing: Some perforations may take 6-12 months but can still close spontaneously if signs of healing are present at 6 months 3
Factors That Accelerate Healing
Wet perforations with bloody or watery discharge heal significantly faster (average 16 days) compared to dry perforations (average 28 days). 4, 2 This occurs because the serosanguinous discharge promotes earlier granulation tissue formation and epithelial migration. 4
Factors That Delay Healing
Several conditions prolong the healing time beyond the typical 2-4 week window:
- Perforation involving the malleus or umbo: Extends healing time to 41.6 days versus 23.8 days for perforations without ossicular contact 2
- Large perforations (≥50% of tympanic membrane): Significantly delay closure 5
- Secondary infection: Middle ear infection substantially prolongs healing 5
- Pre-existing tympanosclerosis: Most prominent cause of healing failure 4
- Penetrating injuries through the ear canal: Associated with delayed healing and higher non-healing rates 5
Critical Management During Healing Period
Keep the ear completely dry to prevent bacterial contamination, particularly from Pseudomonas aeruginosa and Staphylococcus aureus, which cause secondary otitis externa and complicate healing. 6
- Cover the ear canal opening with an earplug or petroleum jelly-coated cotton before showering or hair washing 7
- Avoid swimming and water activities during the healing period 6
- Do not insert anything into the ear canal, including cotton-tipped swabs 7
If infection develops, use only non-ototoxic topical preparations such as fluoroquinolone drops (ofloxacin or ciprofloxacin), never aminoglycosides, which can cause permanent hearing loss. 7, 6, 8
When to Reassess
Reassess at 2 weeks if symptoms have not resolved, as this suggests either infection or healing complications. 6, 9 The American Academy of Otolaryngology-Head and Neck Surgery recommends this timeframe to identify patients who may need intervention. 6
For perforations that show signs of healing at 6 months but remain open, continued observation may be appropriate as spontaneous closure can still occur. 3 However, perforations that remain unhealed for ≥10 months are candidates for surgical repair (myringoplasty or tympanoplasty), which achieves 80-90% anatomic closure. 8
Common Pitfalls to Avoid
- Ear syringing or irrigation: This intervention significantly increases non-healing risk and should never be performed on suspected or confirmed perforations 5
- Using ototoxic ear drops: Aminoglycoside-containing preparations can cause permanent sensorineural hearing loss when the tympanic membrane is not intact 7, 6
- Premature surgical intervention: Given the 89-94% spontaneous healing rate, early surgery is rarely indicated unless there is evidence of ossicular damage or other middle ear pathology 1, 2