The ear drum is a delicate membrane that divides the middle and inner ear from the ear canal. The external ear (the visible part) captures sound waves that move along the ear canal. These waves cause the eardrum to vibrate. This vibration is then passed on through the small bones (ossicles) in the middle ear, and then into the inner ear, where it activates nerve endings and sends signals to the brain.
Should a hole or tear (perforation) form in the ear drum, it won’t vibrate normally, resulting in sounds not being sent to the brain. Additionally, a hole or tear can allow dirt or fluid to enter the middle ear.
A hole in the eardrum can result from several factors. For kids, the leading reason is usually an ear infection. This infection disrupts the equilibrium of pressure on both sides of the eardrum, leading to the accumulation of fluid in the middle ear. This situation might result in a hole or tear in the eardrum.
Additionally, they can occur due to injury to the ear, like a strong blow or loud sound, or by inserting objects such as cotton swabs into the ear canal. Perforations might also happen when the pressure outside the ear is higher than the pressure within the middle ear, for example, during scuba diving or flying at high altitudes.
Regular infections are a hallmark of a perforated eardrum. In between infections there is often no symptoms. If the perforation is large then hearing loss can be present.
Large holes in the ear drum can be identified by examining the ear with a handheld otoscope which you will often see in GP practices and A&E. In ENT clinic I use a microscope which is more powerful and can pick up even the smallest of holes and other subtle defects.
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