A perforated ear drum means there is a hole in the ear drum.

There are various reasons why the ear drum might develop a perforation (technically called tympanic perforations). They include:

1- Ear infections – This can cause fluid to build up and press on the eardrum.
2- Extreme pressure changes – This happens during scuba diving if you move up or down in the water too quickly or rarely when landing in an airplan. It is called “barotrauma.”
3- Poking the eardrum – This happens if you poke an ear bud, bobby pin, or other object into your ear canal.
4- Injury to the ear drum-This happens from a blow or a slap to the cheek

Quite often a hole in the eardrum may heal itself. Sometimes it does not cause any problems. However it may cause recurrent infections with a discharge from the ear. If you have an infection you should avoid getting water in the ear. If the hole in the eardrum has only just occurred, no treatment may be required

Some people do not have symptoms. For others, symptoms include:

1- Very bad ear pain
2- Ear pain that suddenly gets better
3- Clear, pus-colored, or bloody fluid draining from the ear
4- A buzzing or ringing sound in the ear
5- Trouble hearing or hearing loss

A mild hearing loss might ensue with an ear drum perforation. Elimination of hearing loss by closure of the ear drum perforation is not guaranteed. This may be because of additional injury to the cochlea within the inner ear or to the small bones of the middle ear

The operation to repair the ear drum is called a myringoplasty

There are three main reasons closure is advised and performed:

1- To protect the middle ear from the external environment.
2- To prevent water from getting in to the middle ear, which could cause infection.
3- To improve in hearing

Not every perforation needs to be, or should be, closed. Each patient is managed in accordance with what is best for the patient. Poor surgical candidates include the following:

1- Too young (generally less than 8 years)
2- Advanced age (generally above 65 years)
3- Presence of an active ear infection or CSOM not responding to medication
4- Presence of choleasteatoma (abnormal accumulation of skin in the middle ear)
5- Uncontrolled allergies
6- Eustachian tube that is not working properly
7- Only one good hearing ear.
8- Unrealistic patient expectations

The operation is almost always done under general anaesthetic. A cut is made behind the ear or above the ear opening. Occasionally, the ENT surgeon may need to widen the ear canal with a drill to get to the perforation. The material used to patch the eardrum is taken from either underneath the skin (fascia) or from the outer part of the ear (cartilage). This eardrum ‘graft’ is placed against the eardrum. Dressings are placed in the ear canal. You may have an external dressing and a head bandage for a few hours

The graft typically takes 4-6 weeks to heal. Water restriction and ear hygiene should still be meticulously employed during this period