Can an Eardrum Rupture With Ear Tubes in Place?

More Ear, Nose & Throat Articles

Can an Eardrum Rupture With Ear Tubes in Place?

By Your Health Magazine Health Information Team

Your child has ear tubes, but suddenly there is pain, drainage, or blood coming from an ear. Does that mean the eardrum ruptured even though a tube was supposed to prevent pressure from building up? An eardrum rupture with tubes is possible, but drainage through a functioning tube is more common and does not automatically mean there is a new tear.

Can an Eardrum Rupture With Tubes in Place?

Yes. A person can develop a new tear or perforation in the eardrum while an ear tube is still present. Ear tubes reduce certain risks by ventilating the middle ear and allowing trapped fluid to drain, but they do not protect the eardrum from every type of injury or infection.

It also helps to understand that an ear tube already sits in a small, surgically created opening in the eardrum. That controlled opening is not usually described as a rupture. When people ask about an eardrum rupture with tubes, they may be referring to one of three situations:

• A new tear has developed elsewhere in the eardrum.
• The opening around the tube has become larger or has failed to close after the tube moved or came out.
• Fluid is draining through the tube because of a middle ear infection, which can resemble drainage from a rupture.

An examination is usually needed to tell these situations apart.

Why a Rupture May Still Occur

Ear tubes help equalize pressure and reduce fluid buildup behind the eardrum. This may make pressure-related rupture from an ear infection less likely, but several problems can still damage the membrane.

Middle ear infection

Ear infections can still occur when tubes are in place. A working tube often allows infected fluid to drain before substantial pressure develops. However, pressure may still rise if the tube is blocked, displaced, or no longer functioning properly. Infection and inflammation can also weaken eardrum tissue.

Direct injury

Cotton swabs, hairpins, toys, fingernails, and other objects placed in the ear can puncture the eardrum regardless of whether a tube is present. A forceful slap to the ear or a head injury can also cause a tear.

Sudden pressure changes

Rapid pressure changes associated with scuba diving, explosions, airbag deployment, or other forms of barotrauma can injure the eardrum. Functional ear tubes assist with pressure equalization, but they cannot guarantee protection from an extreme or sudden pressure change.

Loud blasts

An explosion or very loud sound close to the ear can rarely tear the eardrum. This type of acoustic trauma may also damage structures deeper in the ear, so prompt medical assessment is important.

Is Ear Drainage a Sign of Rupture?

Not necessarily. Drainage is common when a person with a functioning ear tube develops a middle ear infection. The fluid may be clear, cloudy, yellow, green, blood-tinged, or foul-smelling. Because the tube provides an exit route, the infection may cause drainage without the intense pressure and pain associated with an infection behind an intact eardrum.

A small amount of blood can also occur if the ear canal or tissue near the tube becomes irritated. Nevertheless, new bleeding, persistent drainage, worsening pain, or a noticeable change in hearing should be discussed with a healthcare professional.

Possible Symptoms of a New Eardrum Tear

Symptoms vary depending on the cause, location, and size of the perforation. Some small tears produce few obvious symptoms. Possible signs include:

• Sudden ear pain, sometimes followed by rapid pain relief
• Clear, pus-like, or bloody drainage
• Muffled hearing or a sudden reduction in hearing
• Ringing, buzzing, or other noises in the ear
• A feeling of fullness in the ear
• Dizziness, spinning, nausea, or balance difficulty

These symptoms are not specific to a rupture. A blocked tube, ear infection, earwax buildup, or irritation of the ear canal can cause similar complaints.

How the Ear Is Evaluated

A pediatrician, primary care clinician, or ear, nose, and throat specialist can examine the ear with an otoscope. An ENT specialist may use a microscope for a more detailed view, particularly when drainage or debris makes the eardrum difficult to see.

The examination can determine whether the tube is open, blocked, displaced, or surrounded by irritated tissue. It can also reveal a separate tear or an enlarged opening. A hearing test may be recommended if hearing seems reduced, symptoms persist, or the perforation appears significant.

What Treatment May Involve

Treatment depends on whether the problem is drainage through the tube, a new rupture, or a persistent opening. Many small eardrum perforations heal without surgery, but the ear should be protected while healing.

• Do not place cotton swabs or other objects in the ear canal.
• Use ear drops only when recommended by a healthcare professional. Not every ear product is appropriate when the eardrum has an opening.
• Follow the clinician’s instructions about swimming, bathing, and keeping water out of the ear.
• Attend follow-up visits so the tube and eardrum can be rechecked.

Routine water precautions are not required for everyone with uncomplicated, functioning tubes. A suspected rupture is different, however, and temporary water protection may be advised until the ear is evaluated.

If an infection is present, a clinician may prescribe ear drops selected for use with a tube or perforated eardrum. A hole that does not close may eventually require an office patch or surgery such as myringoplasty or tympanoplasty.

What Is a Persistent Perforation?

Most short-term tubes eventually fall into the ear canal, and the small opening in the eardrum closes. Occasionally, it remains open. This is called a persistent tympanic membrane perforation rather than a sudden rupture.

Persistent openings are more likely with long-term tubes, repeated tube placement, extended tube retention, and a history of frequent drainage or inflammation. Guidance from the American Academy of Otolaryngology–Head and Neck Surgery estimates that a persistent hole occurs in about one or two out of every 100 children after a short-term tube, with a higher risk after long-term tubes.

Families considering tube placement can also review practical information about the cost of ear tube surgery and ways to pay for it.

When to Seek Care

Arrange an evaluation when there is new ear drainage, bleeding, pain, reduced hearing, or concern that the tube has moved. Contact a pediatrician, primary care clinician, or ENT specialist promptly for severe pain, fever, ongoing drainage, significant hearing loss, an object lodged in the ear, or symptoms following a blow to the head or ear.

Urgent medical care may be appropriate for severe dizziness, repeated vomiting, facial weakness, sudden major hearing loss, or clear fluid draining after a significant head injury. General information about ear conditions and other medical concerns is also available through MedlinePlus health topics.

The main takeaway is that ear tubes lower pressure and improve drainage, but they do not make the eardrum immune to injury. Because drainage through a tube can look similar to drainage from a rupture, an ear examination is the safest way to identify what is happening and whether treatment or follow-up is needed.