July 12, 2016

What’s that in my kid’s ear? Injuries and infections can cause eardrum perforation. Here’s what to do.


Some kids just love to put things in their ears. Beads, coins, food, a brand-new pencil, you name it. This is very common, but sometimes this habit can cause serious injury to the ear. Here are some common questions parents have about eardrum injuries:


What is the eardrum and what does it do?

The ear has three main areas: the external ear, the middle ear and the inner ear. The external ear includes both the visible ear on the side of the head as well as the ear canal.

The middle ear contains three small bones called ossicles. The middle ear’s main job is to pick up sound from the ear canal, amplify it and pass it along these bones to the nerve of hearing in the inner ear. This area also includes important nerves and blood vessels. This is the part of the ear where kids typically get ear infections, and when you hear “fluid in the ear,” usually it’s in this part of the ear.

The inner ear houses the nerves of hearing and balance that send signals to the brain.

The eardrum (also called the tympanic membrane) is a thin piece of tissue that separates the external ear from the middle ear. It’s a major amplifier of sounds. When sound waves hit the eardrum, it starts a vibration that passes through the ossicles until it reaches the inner ear. The eardrum also protects the sensitive middle ear from dirt, water and other foreign objects.


What causes eardrum perforations (holes in the eardrum)?

The most common cause of perforations in children is ear infections. Usually kids will complain of ear pain before the perforation because pressure is pushing against the eardrum. If the eardrum pops, the pain usually gets better, but you may see drainage of infected fluid from the ear canal. The good news is that most such holes close without treatment. However, another major cause of perforations is injury to the eardrum, usually from sticking something in the ear like a pencil or cotton swab.


What problems can arise from an eardrum perforation?

A perforated eardrum can cause decreased hearing, pain, sensitivity to water and ear drainage. Rarely, after an eardrum has been damaged, some of the skin from the ear canal or outer part of the eardrum can start growing in the middle ear. This is called a cholesteatoma, and it’s a serious problem that needs treatment by an ear, nose and throat (ENT) surgeon.


What tests will my child need if he or she has an eardrum perforation?

If there’s no sign of cholesteatoma and the eardrum doesn’t rapidly heal by itself, your child should have a hearing test and an ear exam. If your child’s doctor is worried about a cholesteatoma, he or she may also ask for a detailed image of the middle ear with a CT scan.


What treatments are available and do all perforations need to be treated?

Most eardrum perforations heal without treatment. Your child’s primary doctor may refer you to an ENT surgeon. If the perforation gets worse over time or doesn’t heal after about 12-18 months, surgery may be recommended. Your ENT doctor will help you understand the surgery that best fits your child’s needs. Most surgeries to fix this problem are relatively fast outpatient procedures with very little pain afterward.


Siva Chinnadurai, M.D. is a pediatric otolaryngologist at Monroe Carell Jr. Children’s Hospital at Vanderbilt. A St. Louis native, he came to Vanderbilt from the Mayo Clinic and enjoys traveling with his wife, Kelsey.