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Burst Ear Drum (Burst eardrum) in Children

This article is targeted to parents who have children with middle ear problems.

For  burst eardrum  problems in adults, please click hear

Disease/Disorder Name: Perforation of the Eardrum
ICD-9 Description: Perforation, Central, Tympanic membrane
Description:   Perforation of the eardrum is a rupture of the tympanic membrane. Also called a "Burst Eardrum".
 

© Copywrite Mike Saunders. Used with permission

A healthy ear drum - note the pink, healthy look

A burst ear drum - notice the raw, inflamed look which also denotes an infection

Causes of a burst eardrum

External Causes of a Burst Eardrum

An external cause for a burst eardrum is a head trauma such as a blow to the ear or an object penetrating the ear canal and penetrating the eardrum. An immediate trip to the emergency room is mandatory. The ER nurse or doctor will clean the ear carefully give you an antibiotic shot and antibiotic ear drops, then prescribe antibiotic tablets for a 10 day regimen. In severe cases, you may undergo immediate emergency surgery. For less serious cases, you will be referred to an ENT specialist (Ear, nose, Throat specialist) for outpatient surgery. Depending on the damage, surgery could be minor, or major, where the middle or inner ear components are damaged.

Usually, the larger the perforation, the greater the loss of hearing. The location of the hole (perforation) in the eardrum also effects the degree of hearing loss. If severe trauma (e.g. skull fracture) disrupts the bones in the middle ear which transmit sound or causes injury to the inner ear structures, the loss of hearing maybe quite severe.

With a traumatic or explosive event, the loss of hearing can be great and ringing in the ear (tinnitus) may be severe. In this case the hearing usually returns partially, and the ringing diminishes in a few days.

Side effects of a perforated eardrum (burst eardrum) from external causes will definitely be excruciating pain. You will probably also suffer from vertigo and/or tinnitus until the problem is resolved. However, there have been many cases where, even after healing, vertigo and/or tinnitus persisted.

Internal causes of a Burst Ear Drum

A burst eardrum from internal causes is usually caused by a build-up of bacterial waste from an infection in the middle ear. In the final stages of a middle ear infection, if the pressure becomes too much, and the Eustachian tube is blocked, the eardrum may burst outward. This is actually a positive event if controlled properly. The burst eardrum will immediately relieve the pressure in the middle ear and the accompanying earache will diminish. Your child will stop screaming :)

A smelly discharge (bacteria detritus from the middle ear) will spill out of the ear and can be sopped up with a wet rag or a tissue. Under no circumstances use ear cleaners with a cotton tip to attempt to clean the ear canal past 1/2". Such action may cause irreparable harm to the eardrum!

Symptoms of a pre- burst eardrum due to middle ear Infection (prior to bursting)

  • Extreme earache with accompanying screaming/ moaning
  • Headache
  • Fever (101° F -104°F)
  • Stuffiness feeling with hearing
  • Mild deafness
  • Difficulties in sleeping
  • Loss of appetite.

Causes of middle ear infection can be either viral or bacterial and caused by:

  • A progressive head cold
  • A viral sinus infection
    • A sealed Eustachian tube
  • A bacterial infection that causes
    • A sealed Eustachian tube
    • A buildup of bacterial waste in the middle ear
  • An otitis externa infection left too long that spreads to the inner ear
  • Blowing the nose too hard, forcing sinal mucous into the middle ear which then deteriorates
  • An opportunistic bacterial infection entering through a perforated eardrum

Treatment for Burst Eardrum from internal causes

 The treatment your doctor (family or pediatrician) offers for a burst eardrum will depend on how long your child has had had the infection and the number of prior incidents of a similar infection.

There are three methods of treatment for burst eardrum:

1. Let Nature Take Its Course

If it is a known viral infection, then the infection should be allowed to run its course as no antibiotics will combat a virus.

Many children recover naturally from a burst eardrum in 2 - 3 weeks (80% +/-). As a parent, self medication can be initially performed on your child by obtaining an OTC (Over The Counter) pediatric oral decongestant. This protocol will allow two things to happen:

  1. It will thin the middle ear fluid in the ear to make it easier to drain away.
  2. It will hopefully dry the nasal passages and shrink the swollen Eustachian tube tissues so that it opens and any the middle ear fluid drains into the throat.

To alleviate some of the pain, a pediatric dose of any of the following can be given:

  • NOT ASPIRIN (Acetaminophen) (see note below)
  • Ibuprofen(Tylenol™) etc. (No more than 4 a day every 4 hours for 7 days - see Note 2)
  • paracetamol/acetaminophen
  • ibuprofen+codeine (eg. Vicodin™) (Doctor's prescription only)

Note: In rare cases, some children have acquired a rare and sometimes fatal disease called Reye's syndrome after taking Aspirin (acetylsalicylic acid and pain relievers containing it). Although a very rare disorder (the chances of a child acquiring the disorder is approximately 1 in 1,100,000 of children 15 and under in the USA (1990-91)), when it is your child, it is better to be safe than sorry.

Note 2: For children under 10, no more than 500 milligrams per day; for pre-teens under 16 years old, no more than 750 milligrams per day. Continued high doses of ibuprofen (in adults, over 2000 milligrams per day for over 30 days) have been shown to increase the likelihood of  intestinal bleeding and liver failure.

For a comparison of pediatric doses of ibuprofen and acetaminophen, click here

2. Antibiotics

If the infection has a known bacterial cause, antibiotics are sometimes prescribed, often initially by injection, then a regimen orally three times a day for at least 7 days.  In children, a penicillin-derivative called amoxicillin or augmentine is often used. Pediazole®, a brand-name combination of erythromycin and sulfisoxazole can be used if a child is allergic to penicillin or penicillin-derivative products.

****However, before you ask a pediatrician or family doctor for antibiotics, you may want to read the latest from the American Academy of Pediatrics.

Note Also: In the past, antibiotics such as penicillin, erythrosine, or erythromycin were prescribed. However, in the last few decades, many in the general population have become immune to the effects of these antibiotics, and stronger ones are often prescribed. (The cause of immunity is often blamed on antibiotics fed to the food supply (chickens and beef) before they are brought to market. )

Doctors usually adopt a wait-and-see approach to begin with as the torn eardrum often heals over time (3-6 weeks).

These approaches are usually effective for most children. If your child continues to have problems, your doctor may decide to refer you to an ear, nose and throat (ENT) or head and neck surgical specialist. These two specialist categories have been trained to perform surgery on all parts of the ear.

3. Surgical Treatments for a eardrum that does not close

 If the tear or hole in your child's eardrum doesn't heal by itself, physical intervention through surgery is performed to close the perforation. There are surgical treatments that can be employed::

Myringoplasty (minor surgery)

Long Term Effects of a Burst Eardrum on Hearing

The long term effects of a burst eardrum and subsequent operations on the ear will be a function of the size of the hole that was repaired, and how many times the eardrum has to be worked on before the hole is completely healed. With any tissue that heals, there is scar tissue residue; with any operation on body tissue, there is also scar tissue residue. Scar tissue is the natural end-result of a successfully healed eardrum.

The eardrum's purpose is to vibrate. the buildup of scar tissue inhibits that vibration function; the greater the scar tissue, the less the eardrum will vibrate, affecting the ability to hear. As a rule of thumb, a hole in the eardrum that heals on its own within a few weeks or months will have minimal effect on hearing. However, continual operations on the ear drum will build up scar tissue and could cause severe hearing loss due to the subsequent scar tissue making the  tympanic membrane inflexible.

A myringoplasty should only affect hearing loss to a maximum of 5%. Then again if the surgeon does an excellent job with a tympanoplasty and the hole is relatively small, hearing loss will be negligible. If there is more serious additional damage to the ossicles in the middle ear requiring an operation, the results could affect hearing quite negatively. 

Summary

In 80% of cases, the eardrum will heal on its own with perhaps the assistance of antibiotics. Myringoplasties (Tympanoplasties) are routine operations performed at either Childrens' Hospitals or General hospitals.

 
 







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