MechanismThe tympanic membrane (TM) is a tissue separating the external ear from the middle-ear space. It is attached to a chain of small bones (auditory ossicles) located in the middle ear. The TM also serves as a barrier between the sterile middle-ear space and the ambient environment.
Eardrum rupture may be caused by descending without equalizing the pressure in the middle ear, by a forceful Valsalva maneuver, explosion, a blow to the ear/head, or acoustic trauma. It is usually accompanied with pain; rupture relieves the pressure (and pain) in the middle ear and may be followed by vertigo. There may be some bleeding in the ear canal.
Contributing factors include congestion, inadequate training and excessive descent rates.
- Ear pain during descent that stops suddenly
- Clear or bloody drainage from ear
- Hearing loss
- Ringing in the ear (tinnitus)
- Spinning sensation (vertigo)
- Nausea or vomiting that can result from vertigo
ManagementMost perforated eardrums will heal spontaneously within a few weeks. It may be necessary to treat nasal and sinus congestion. If the tear or hole in your eardrum does not heal by itself, treatment will involve procedures to close the perforation. These may include:
- Eardrum patch: An ENT specialist may seal the tear or hole with a paper patch. This is an office procedure in which an ENT applies a chemical to the edges of the tear to stimulate growth and then applies a paper patch over the hole to provide a support structure for the growth of eardrum tissue.
- Surgery: Large eardrum defects may be fixed by surgery (tympanoplasty). An ENT surgeon takes a tiny patch of your own tissue and plants it over the hole in the eardrum. This procedure is done on an outpatient basis, meaning you can usually go home the same day unless medical conditions require a longer hospital stay.
Fitness to DiveIf your physician feels the healing is solid and there is no evidence of Eustachian tube problems, you can return to diving within several months. Chronic perforations that do not heal are a contraindication to diving.
PreventionDo not dive with congestion. Maintain a comfortable rate of descent, and equalize as needed.
O’Neill Grading SystemThe O'Neill grading system is a new way to grade the severity of middle-ear barotrauma. It is simplified and is expected to provide more consistent diagnosis with sufficient details to direct the treatment.
Grade 0 Eustachian Tube Dysfunction
- Baseline photo depicting anatomical appearance of the TM before exposure to pressure
- Symptoms with no anatomical change (no trauma) from baseline
Grade 1 Barotrauma
- Erythema increased from baseline
- Fluid or air trapping (visible bubble) in the middle-ear space
Grade 2 Barotrauma
- Any bleeding noted within the tympanic membrane or middle-ear space