Treatments: Ear Drum Perforation (Tympanic Membrane Perforation)

This page describes the treatment options for a hole in the eardrum, from watchful waiting to office patching and tympanoplasty.

A hole in the eardrum can often heal, and there are several ways to treat it. The approach depends on how big the hole is, what caused it, whether there is an infection and whether hearing is affected. This page describes the main treatment options, what recovery looks like, and the possible results and risks. The condition itself is described on the ear drum perforation conditions page.

Watchful Waiting: Giving the Eardrum a Chance to Heal on Its Own

Many eardrum holes close by themselves without any procedure. This is especially true for small holes and for holes caused by a recent injury (such as a slap to the ear, a cotton swab or a sudden pressure change).

• Most holes caused by injury heal on their own, often within about 1 to 3 months, with an average of around 3 to 4 weeks.

• Holes that follow an ear infection in childhood also close on their own in a large majority of cases, usually within weeks.

• Larger holes are less likely to close on their own. When a hole is bigger than about one quarter of the eardrum, the chance of healing without treatment drops, and more than half of very large holes may not close by themselves.

During watchful waiting, the ear is usually rechecked over time to confirm the hole is closing. A hearing test may be done to measure any effect on hearing.

Keeping the Ear Dry

A long-standing principle of care is to keep water and moisture out of the ear canal while the eardrum heals. Water that gets through the hole into the middle ear can introduce bacteria and lead to infection. Common dry-ear precautions include:

• Avoiding getting water directly in the ear during showers and washing.

• Not swimming or submerging the head until cleared by the treating clinician.

• Using a cotton ball coated with petroleum jelly, or a fitted earplug, to block the ear during bathing when advised.

• Avoiding ear drops unless they are specifically prescribed.

Research is ongoing into whether a moist environment created by sterile, non-toxic ear drops might speed healing, similar to how moist conditions help skin wounds heal. Some studies suggest certain antibiotic drops can shorten healing time, but keeping the ear dry remains the standard first-line approach in current guidance.

Treating Infection

If the ear is draining fluid or is infected, controlling the infection is an important part of treatment. A persistently infected, draining ear is less likely to heal and can lead to longer-term problems. See ear infection treatments.

• Antibiotic ear drops are the preferred treatment for a draining ear and are usually more effective than antibiotic pills, because drops deliver a much higher concentration of medicine right where it is needed.

• Quinolone-type drops (such as ofloxacin or ciprofloxacin) are often chosen because, unlike some older antibiotics, they are not harmful to the inner ear.

• Gentle cleaning of discharge from the ear canal by a clinician can help the drops work better.

• Adding antibiotic pills usually offers little extra benefit over drops alone for a simple draining ear.

Office Patching Procedures

When a hole does not close on its own, or to encourage faster healing, it may be treated in the office without formal surgery. These procedures place a material over or into the hole to act as a scaffold that cells can grow across.

• Paper patch: A small piece of specially treated paper is placed over the hole, sometimes after gently freshening the edges. The patch supports the natural migration of skin cells across the gap and can shorten healing time. It is one of the oldest, simplest and least expensive methods and is well suited to small holes. More than one patch may be needed, and a dry ear and the cause of the hole affect the chance of success. See paper patch myringoplasty recovery.

• Fat graft myringoplasty: A small piece of the patient's own fat (often taken from behind or in front of the ear, or from the earlobe) is used to plug the hole. This can be done under local anesthesia and does not require lifting up the eardrum. It works best for small to medium holes (generally under about one third of the eardrum).

In studies of small holes, closure rates have been reported around 67% for paper patch and about 87% for fat grafting; the two approaches have generally produced similar results overall. For larger or longstanding holes, these office techniques are less reliable than formal surgery, and newer approaches add healing-promoting substances to try to improve results.

Tympanoplasty Surgery

Tympanoplasty is the main surgical operation to repair the eardrum. It is generally considered for holes that do not heal on their own, larger holes, holes causing hearing loss or repeated infections, and long-standing (chronic) holes.

• How it works: A graft is placed to rebuild the eardrum. Common graft materials include the patient's own tissue, such as the covering of a nearby muscle (temporalis fascia), cartilage or the lining of cartilage (perichondrium).

• How it is done: The operation can be performed through the ear canal or through a small incision behind the ear. It may be done with a microscope or with an endoscope (a small camera), which can improve the view and may avoid an outside incision.

• Repairing the hearing bones: If the small bones of the middle ear are also damaged, they may be repaired or reconstructed during the same operation. The term tympanoplasty covers several types depending on how much needs to be rebuilt.

Preparation is described in the tympanoplasty surgery packet and the paper patch myringoplasty packet.

Recovery After Surgery

Recovery details vary by procedure and surgeon, but some general patterns are common. More detail is on the tympanoplasty recovery page.

• Many eardrum repairs are outpatient procedures, so going home the same day is typical. Simpler patch procedures can take as little as 10 to 15 minutes.

• Pain is usually mild and can often be managed with over-the-counter pain medicine.

• Dissolvable or removable packing may be placed in the ear canal to hold the graft in position. Packing is typically removed at a follow-up visit, often around 2 weeks after surgery.

• Antibiotic ear drops are often prescribed for a short period after surgery.

• The ear is kept dry. Showering is often allowed soon after surgery as long as water is kept out of the ear, but submerging the ear and getting soapy water in it are avoided.

• Driving and important decisions are commonly avoided for about 24 hours after anesthesia.

• A follow-up hearing test is usually done several weeks to a couple of months after surgery, with additional checkups over the following months to confirm the eardrum has healed.

Results

• Surgery is generally the most reliable way to close a hole. Studies of surgical repair report closure rates of roughly 88% to 100%, which are higher than with watchful waiting.

• A successful repair aims to close the hole, improve hearing and reduce the risk of future ear infections.

• Hearing improvement is measured by how much the gap in hearing narrows. A very good hearing result is often defined as closing that gap to within 15 decibels, and a satisfactory result as within about 20 to 30 decibels.

• Several factors affect success, including the size and location of the hole, the condition of the middle ear lining, whether the ear is dry at the time of surgery, smoking and the surgeon's experience.

Risks and Things to Consider

No treatment is guaranteed, and each option carries trade-offs:

• The hole may not close, or may reopen, and a repeat procedure is sometimes needed.

• A new hearing problem, or a change in taste on one side of the tongue, can occur if a small nerve near the eardrum (the chorda tympani) is affected during surgery.

• Infection, bleeding, dizziness or ringing in the ears can occur after a procedure.

• Leaving a chronic hole untreated has its own risks, including ongoing hearing loss, repeated infections and drainage, and in some cases a buildup of skin in the middle ear (cholesteatoma) that may require surgery.

• Surgery involves cost, time off and the usual risks of anesthesia, while office patch procedures are quicker and simpler but less reliable for large holes.

Questions Often Discussed With an Ear Specialist

• How big is the hole, and how likely is it to heal on its own?

• Is there an active infection that needs treatment first?

• Is an office patch procedure a reasonable option, or is surgery the better fit?

• What type of repair is being considered, and what results are expected in this situation?

• What are the specific risks, and what does recovery involve?