American Medical Association Family Medical Guide - American Medical Association [720]
Ruptured or perforated eardrum
An object inserted into the ear, a middle ear infection, or an injury to the ear can cause a ruptured or perforated eardrum.
Acute Middle Ear Infections
An acute infection of the middle ear is a bacterial infection that usually follows a viral infection of the upper respiratory tract—such as a cold (see page 648), the flu (see page 649), or measles (see page 437)—that inflames the cells that line the middle ear cavity. Bacteria can enter the middle ear through a ruptured or perforated eardrum (see previous page). Persistent sinusitis (see page 651) often leads to a middle ear infection. Middle ear infections develop most often in children and frequently recur.
Symptoms
The symptoms of an acute middle ear infection can include a feeling of fullness or pain in the ear that may be mild or severe enough to interfere with sleep and daily activities. Other possible symptoms include chills, fever, sweating, and hearing loss in the affected ear.
If the infection is severe and is not treated, the pressure of pus collecting in the middle ear can rupture the eardrum (see previous page), producing a discharge of pus, sometimes with blood, that relieves the pain.
If you have symptoms of an acute middle ear infection, see your doctor. If treatment is delayed, the infection can spread to the mastoid bone (the bone behind the ear) and become a chronic infection (see right).
Diagnosis
To diagnose an acute infection of the middle ear, a doctor will examine your ear with a lighted viewing instrument called an otoscope. He or she also may take a sample of fluid from the ear for examination in a laboratory.
Treatment
To treat an acute infection of the middle ear, doctors usually prescribe antibiotics. In some cases, the eardrum ruptures and drains while a person is taking antibiotics. The pain usually subsides within a day or two, but fluid may be present for several weeks and cause hearing loss. If your child has an acute middle ear infection, the doctor will ask you to bring him or her in again for another evaluation within the next 6 weeks. If an acute infection of the middle ear is unusually prolonged and painful or if complications such as paralysis of a facial nerve (Bell’s palsy; see page 696) develop, a doctor may recommend an outpatient procedure called myringotomy (see page 418) to remove the fluid, which helps clear up the infection.
Chronic Middle Ear Infections
Chronic middle ear infections are often the result of an ear infection that clears up but leaves a perforation or pocket that harbors bacteria and therefore is susceptible to infection. A ruptured or perforated eardrum (see previous page) that has not healed or an abnormal growth in the middle ear (cholesteatoma; see next page) can also cause a chronic infection of the middle ear.
In rare cases, the bones of the ear may become damaged, or scar tissue may fuse the bones together and prevent them from transmitting sound signals to the brain, causing permanent hearing loss.
Symptoms and Diagnosis
A chronic infection of the middle ear can produce grayish or yellowish pus that seeps from the ear periodically. The infection may cause some hearing loss, depending on how long the infection has been present.
If you have symptoms of a chronic middle ear infection, your doctor will refer you to an otolaryngologist (a doctor who specializes in disorders of the ear, nose, and throat). The otolaryngologist will examine your ear with a lighted viewing instrument called an otoscope and may perform a hearing test (see page 1016). He or she may also examine your ear with a microscope and may order a CT scan (see page 112) of your head to determine if the infection has spread.
Treatment
To treat a chronic middle ear infection, a doctor usually cleans out the ear and prescribes eardrops that contain an antibiotic (to kill the bacteria) and a corticosteroid (to reduce inflammation) or an oral antibacterial medication.
If the infection does not respond to medication, the doctor may recommend a surgical procedure