One of the most common reasons we see patients at Dallas Ear Institute is for perforated eardrum. Patients may be suffering from recurring infections and hearing loss. They may not be able to swim without fear of pain or developing an ear infection. Although we can often repair a perforated eardrum, for some, surgery is frightening. As a result, we are frequently asked, “Is it safe to leave a hole in the eardrum unrepaired?” To answer this question, let’s consider the risks and benefits of repairing the perforated eardrum against the risks and benefits of living with the it unrepaired.
What are the risks and benefits of repairing a tympanic membrane?
A ruptured eardrum results in abnormal communication between the ear canal and the middle ear. Put another
way, there is access from the outside world to the insides of the body. Moisture and germs get access to the middle ear which is meant to be isolated from the outside world. This can result in frequent infections, water intolerance, increased size of the perforation, and further hearing loss. In rare cases, it can lead to skin and infection trapped behind the eardrum in the middle ear called cholesteatoma.
Surgery to repair the eardrum restores the natural barrier between the middle ear and the ear canal. This mitigates the risk of infection to the middle ear. With a sealed eardrum, you can live confidently knowing that your ear has been medically stabilized. You may be able to swim and submerge your ear without pain or concern. And in some cases, hearing loss is restored. There are many benefits to having the perforated eardrum repaired.
As far as the risks are concerned, they are rare. Surgery is done under general anesthesia in an outpatient surgery center. This means you are completely asleep and unaware during surgery, and you go home after surgery without staying in the hospital. Hearing loss occurs in less than 1% of cases. Injury to important surrounding anatomy like the facial nerve or the temporal lobe is less than 0.1%. Many patients experience swelling of the ear, soreness of the jaw, and numbness of the tongue, but these are usually temporary. Overall, the benefits far outweigh the risks.
Typically, we recommend planning for 1 week off work although returning to work in a couple days is often possible. We prefer you to avoid traveling by plane for a few weeks. You should keep water out of your ear canal for a few months while the ear is healing.
What are the risks and benefits of living with a perforated eardrum?
As outlined above, the risks of living with a perforated eardrum include the suffering associated with recurring infections, increasing perforation, decreasing hearing, and possible cholesteatoma formation. Patients should avoid activities that risk water in the ear canal. Although some may wish to avoid the inconveniences of surgery, be frightened of surgery, want to avoid missing work/school, or avoid the cost of surgery, it is difficult identify any true benefit from living with a perforated eardrum.
What is the result of the risk benefit analysis?
Considering all the unnecessary suffering and potential complications of living with a perforated eardrum, the benefits of surgery outweigh both the risks of surgery and the risks of living with a perforated eardrum combined. Surgery is safe and effective, downtime is 1 week or less, and the benefits include fewer infections, mitigation of further hearing loss and cholesteatoma formation, improved hearing, and potentially resolution of water intolerance.
