What causes a hole in the eardrum?

Common causes include ear infections (where pressure behind the eardrum causes it to burst), trauma such as a cotton bud pushed in too far or a slap to the ear, sudden pressure changes from flying with a heavy cold or scuba diving, after grommets have come out, long-standing ear disease, and cholesteatoma (a condition in which skin grows in the wrong place behind the eardrum and can erode through it). Often the underlying issue is poor function of the Eustachian tube, the small tube that ventilates the middle ear.

What are the signs of an infected hole in the eardrum?

Signs of infection include discharge from the ear (sometimes yellow, green, or smelly), new or worsening ear pain, a drop in hearing, a blocked or full feeling in the ear, redness or swelling around the ear, and fever (particularly in children). A dry hole with no discharge is usually painless. The most common reason a quiet, painless hole turns into a sore, discharging ear is water entering the ear canal and carrying bacteria into the middle ear — which is why keeping the ear dry is so important.

Can I fly with a hole in the eardrum?

Yes, it is safe to fly with a hole in the eardrum. In fact, flying is sometimes more comfortable than usual because air can pass freely through the hole and pressure does not build up behind the eardrum.

Can I swim with a hole in the eardrum?

You can swim with a hole in the eardrum, but it is strongly recommended to keep the ear dry. Most infections in patients with a hole in the eardrum happen after water has entered the ear and carried bacteria into the middle ear. Practical water precautions include cotton wool coated in Vaseline for showering, off-the-shelf silicone putty plugs, specialist swim plugs, a swimming headband, or custom-made ear plugs from an audiologist for the most reliable seal.

Can I scuba dive with a hole in the eardrum?

Scuba diving is not advised with an open hole in the eardrum. Cold water can enter the middle ear, which can cause sudden vertigo and disorientation underwater, and the risk of infection is significantly increased. Even after surgery to repair the eardrum, return to diving is not guaranteed — the repaired eardrum is not as robust as a native one and Eustachian tube function must be good. Anyone wanting to return to diving after ear surgery should be formally assessed for fitness to dive, in the UK by a UK Diving Medical Committee (UKDMC) medical referee.

Does a hole in the eardrum always need surgery?

No. Even a large hole in the eardrum does not automatically need treatment. The decision is not based on size alone — many large, dry, stable holes cause no day-to-day problems and can be managed with good water precautions. The two main reasons to consider surgery are recurrent ear infections, and to give you a waterproof ear so that you no longer have to keep doing water precautions every time you shower, wash your hair, or swim. Other reasons that sometimes tip the balance include troublesome hearing loss and concerns about underlying ear disease such as cholesteatoma.

What is the aim of surgery to repair a hole in the eardrum?

The operation is called a myringoplasty (or tympanoplasty when more extensive middle ear work is needed). The main aims are to give you a clean, intact, waterproof ear that no longer has to be protected from water, to reduce the risk of recurrent infections, and to allow you to swim, shower, and get on with life without having to think about your ear. Improving hearing is a possible benefit but is not the main reason to operate, as hearing outcomes after surgery are variable.

How can I keep water out of the ear with a hole in the eardrum?

For everyday use such as showering, a small ball of cotton wool smeared in Vaseline placed in the outer ear is simple and effective. Silicone putty plugs such as Mack's Pillow Soft also work well. For swimming, options include pre-shaped reusable plugs, specialist swim plugs such as SurfEars, or a swimming headband worn over the ears. Custom-made ear plugs from an audiologist give the best fit and most reliable seal, and are particularly worth considering for regular swimmers, divers, surfers, or anyone whose work involves water. Reusable plugs should be rinsed in fresh water after every use and allowed to dry fully before storing.

Hole in the Eardrum

Q: Will a hole in the eardrum heal on its own?

Many small holes in the eardrum heal on their own. After a one-off infection or minor injury, the eardrum usually closes within a few weeks, and most that are going to heal will do so within around six to eight weeks. Larger holes, or those linked to ongoing infection or inflammation, are less likely to close without help. As a general rule, if a hole has been there for more than three months, it is unlikely to heal on its own.

Q: How does a hole in the eardrum affect hearing?

A hole in the eardrum usually causes a conductive hearing loss, meaning sound is not being conducted through the ear properly because part of the eardrum is missing and less sound energy reaches the inner ear. The amount of hearing loss depends on the size and position of the hole and is usually mild to moderate. People often describe it as muffled hearing or feeling that one ear is less sharp than the other. The inner ear and hearing nerve are not damaged by a hole in the eardrum.

A hole in the eardrum (sometimes called a perforated eardrum) is exactly what it sounds like: a small hole or tear in the thin membrane at the end of your ear canal. The eardrum has two important jobs. It vibrates in response to sound, which is how you hear, and it acts as a barrier that keeps the middle ear safe and dry. When there is a hole in it, both of those jobs can be affected.

I have looked after a large number of patients with holes in the eardrum, both in my NHS and private practice. Some have been managed with simple measures and watchful waiting, others with surgery. There is no single right answer for every ear. The best plan depends on the size and position of the hole, whether it is wet or dry, how much it is affecting your hearing or your daily life, and what you want to achieve.

The most important message on this page

Before going any further, there is one message I want every patient with a hole in the eardrum to take away: keeping the ear dry is the single most important thing you can do. A painless, dry hole can be perfectly manageable for years. But once water gets in, it carries bacteria straight into a space that is normally sealed off from the outside world, and that is by far the most common reason a quiet, settled ear suddenly turns into a sore, discharging ear. Almost everything practical on this page comes back to that one point.

How does the ear work, and what does the eardrum do?

The ear has three parts:

The outer ear: the part you can see (the pinna) and the ear canal that runs from there into the head
The middle ear: a small air-filled space that begins on the other side of the eardrum and contains three tiny hearing bones
The inner ear: where sound is converted into a signal that travels along the hearing nerve to the brain

The eardrum sits right at the end of the ear canal, where the outer ear meets the middle ear. It is roughly the size of a pencil rubber and only about a tenth of a millimetre thick. When sound waves travel down the ear canal and hit the eardrum, it vibrates, and those vibrations pass through the hearing bones into the inner ear. The eardrum also acts as a seal that keeps the middle ear clean and dry.

What is the Eustachian tube, and why does it matter?

The Eustachian tube is a small tube that runs from the middle ear down to the back of the nose. You cannot see it, but you have probably felt it working. It is the reason your ears "pop" when you yawn, swallow, or come in to land on an aeroplane.

Its main jobs are:

To let air in and out of the middle ear so that the pressure stays equal on both sides of the eardrum
To drain any fluid that builds up in the middle ear

When the Eustachian tube does not work well, for example during a heavy cold, with allergies, with reflux, in children whose adenoids are large, or simply because of how the tube is shaped, the middle ear cannot ventilate or drain properly. Fluid and pressure build up behind the eardrum, which is uncomfortable, can affect hearing, and is the most common reason that ear infections happen. If those infections become severe, the eardrum can burst under the pressure, leaving a hole behind.

So although the hole itself is in the eardrum, it is often the Eustachian tube that has set the whole process in motion. That matters because it can also affect how the ear behaves afterwards. An ear that struggles to ventilate is more likely to have problems again, and this is something I always think about when planning treatment.

Why does a hole happen?

There are several common reasons:

Ear infections, by far the most common cause. Pressure builds up behind the eardrum during a middle ear infection, and the eardrum can burst. This often relieves the pain because the trapped fluid finally escapes.
Trauma, such as a cotton bud pushed in too far, a slap to the ear, a blast or a very loud noise close to the ear, or a sudden pressure change (for example flying with a heavy cold or scuba diving).
After grommets. Occasionally a small hole remains once a grommet has come out, particularly if the grommet has been in place for a long time.
Long-standing ear disease. In some people the ear has had problems on and off for many years, and the eardrum simply does not heal.
Cholesteatoma, a more complex condition in which skin grows in the wrong place behind the eardrum and can erode through it. This is a separate problem that needs a different approach, and I will always check for it when I examine an ear with a hole.

Will it heal on its own?

Often, yes. Many small holes heal by themselves. After a one-off infection or a minor injury, the eardrum usually closes within a few weeks, and most that are going to heal will do so within around six to eight weeks. Larger holes, or those linked to ongoing infection or inflammation, are less likely to close on their own. As a general rule, if a hole has been there for more than three months, it is unlikely to heal without help.

While a recent hole is healing, there are a few simple things that help:

Keep the ear dry
Do not put anything in the ear (including cotton buds and ear drops, unless your doctor has prescribed them)
Try not to blow your nose too hard
Take simple painkillers if it is sore

How does a hole in the eardrum affect hearing?

Most people notice some drop in hearing on the affected side. This happens because part of the eardrum is missing, so it cannot vibrate as well, and less of the sound energy gets through to the inner ear. We call this a conductive hearing loss, meaning sound is not being conducted (passed) through the ear properly.

The amount of hearing loss depends on the size and position of the hole. It is usually mild to moderate, and people often describe it as muffled hearing, hearing better in some situations than others, or feeling that one ear is just less sharp than the other. Importantly, the inner ear and hearing nerve are not damaged by a hole in the eardrum, so the hearing loss caused by the hole itself is generally not permanent in nature.

What are the signs of an infection?

A dry hole, meaning one with no discharge, is usually painless and not particularly troublesome. The reason these ears often do go on to cause trouble is water. Because the middle ear is no longer fully sealed off, water that enters the ear canal can pass straight through the hole into the middle ear, taking bacteria with it. This is by far the most common reason a quiet, painless hole suddenly turns into a sore, discharging ear, and it is exactly why I make such a point of water precautions.

Signs of infection to look out for include:

Discharge from the ear, sometimes yellow, green, or smelly
New or worsening ear pain
A drop in hearing
A blocked or full feeling in the ear
Redness or swelling around the ear
Fever, particularly in children

What should I do if I think the ear is infected?

If you notice any of the above:

Keep the ear dry. Avoid getting water in it while there is discharge.
Do not poke or clean inside the ear with cotton buds. This almost always makes things worse.
See a doctor. Antibiotic ear drops are usually the mainstay of treatment. A gentle microsuction clean of the ear in clinic, where the discharge is removed under the microscope, often settles infections much faster than drops alone.
If the infection is severe or not settling, you may also need oral antibiotics.

Most infections clear up quickly with the right treatment. Recurrent infections through a hole in the eardrum are one of the most common reasons patients come to see me.

Does a hole always need to be treated?

No. Even a large hole in the eardrum does not automatically need treatment. The decision is not based on size alone. Many large, dry, stable holes cause no day-to-day problems and can be left well alone with good water precautions. Many people live perfectly happily with a hole in their eardrum for years.

The two main reasons to consider treatment are:

Recurrent ear infections, when the ear keeps getting infected and discharging despite reasonable care
To give you a waterproof ear, so that you no longer have to keep doing water precautions every time you shower, wash your hair, or swim, and you can get on with normal life without having to think about your ear

Other reasons that sometimes tip the balance include troublesome hearing loss (although a hearing change is not the main aim of surgery, see below), and concerns about other underlying ear disease, such as cholesteatoma, which is a separate problem that does need to be dealt with.

In effect, day-to-day water precautions are doing the job that the eardrum would normally do, keeping water and bacteria out of the middle ear. As long as that is done consistently, many holes cause very little trouble. The reason patients eventually choose surgery is usually either that the ear is still getting infected despite their best efforts, or simply that they have had enough of constantly having to protect it from water.

Can I fly, swim, or scuba dive?

These are some of the most common questions I am asked.

Flying. Yes, it is safe to fly with a hole in the eardrum. In fact, flying is sometimes more comfortable than usual because the air can pass freely through the hole and pressure does not build up behind the eardrum.
Swimming and showering. You can swim and shower, but I generally recommend keeping the ear dry where possible. Most infections happen after water gets in.
Scuba diving. Diving is usually not advised with a hole in the eardrum. Cold water can enter the middle ear, which can cause sudden vertigo and disorientation underwater, and increases the risk of infection.
After surgery to repair the eardrum. Flying and swimming are restricted for a number of weeks while the ear heals, and I will give you specific advice depending on how things are going. Scuba diving is a separate question. A repaired eardrum is not the same as a native one and is generally less able to withstand the pressure changes of diving, particularly if Eustachian tube function is not perfect. For some patients diving may be possible again after a successful repair, but it is not guaranteed and it is never the main reason to operate. Anyone wanting to return to diving after ear surgery should be formally assessed for fitness to dive. In the UK, this is done through a UK Diving Medical Committee (UKDMC) medical referee.

How can I keep water out of the ear?

Because keeping the ear dry is the single most important day-to-day measure, this is worth taking seriously and doing properly. There are several practical options ranging from very simple and cheap through to bespoke, and I am happy to talk through which is most suitable for you.

For everyday use, showering and washing your hair:

Cotton wool coated in Vaseline. A simple, cheap, and very effective barrier. Take a small ball of cotton wool, smear it well in petroleum jelly, and place it gently in the outer part of the ear before getting wet. This is what I most commonly recommend for everyday water protection.

For swimming:

Pre-shaped reusable plugs. Flanged silicone plugs (sometimes called "Christmas tree" shaped) such as WaterDam are inexpensive, reusable, and easy to use. They are fine for general swimming and are particularly good for children.
Specialist swim plugs. Products such as SurfEars are designed for more demanding water use. They use a fine mesh that lets sound through (so you can still hear and equalise) while keeping water out, and are popular with surfers, swimmers, and watersports enthusiasts.
Swimming headband. A neoprene band worn around the head and over the ears, such as the Ear Band-It, gives an extra layer of protection. It can be worn alone for casual use or, more reliably, worn over ear plugs to help hold them in place. This is particularly useful for children, who often dislodge plugs in the water.

For the most reliable seal, custom-made swim plugs:

Custom-made plugs are moulded to the exact shape of your ear canal from a soft impression, so the fit is far better than anything off the shelf. Examples include Snugs Aqua and Bollsen Watersafe, both of which provide custom water-tight ear plugs by post once impressions have been taken. Most high-street audiologists, including those at Boots Hearingcare and Specsavers Hearing, also offer this service, as do many independent audiology clinics. Custom plugs give the best seal, are comfortable to wear for longer periods, and typically last for years. They are particularly worth considering if you swim regularly, dive, surf, sail, or have a job that involves water. I am happy to recommend an audiologist if you would like.

A general rule: the more often you are around water, the more it is worth investing in something that fits properly.

Keeping ear plugs clean

This is just as important as wearing them. Reusable ear plugs and custom moulds spend their life going in and out of an ear that is already vulnerable to infection. If they are not kept clean they can do exactly the opposite of what you bought them for, carrying bacteria straight into the middle ear and triggering an infection. A few simple habits make a real difference:

Rinse your plugs in clean fresh water after every use, especially after swimming pools or the sea.
Allow them to air dry fully before putting them away. Storing damp plugs in a sealed case encourages bacteria and mould.
Once a week or so, give them a deeper clean with mild soap and warm water, then rinse and dry. Avoid alcohol-based cleaners or strong disinfectants, which can degrade silicone over time.
Some custom plug companies (Snugs, for example) sell their own cleaning solution. If so, follow what the manufacturer recommends.
Inspect them regularly. If they become hard, cracked, discoloured, or smelly, replace them.
Always store plugs in a clean, dry case, not loose in a swim bag.
Do not share ear plugs with anyone else.

What is the aim of surgery?

The operation to repair a hole in the eardrum is called a myringoplasty (or tympanoplasty when more extensive work on the middle ear is needed). The main aims are:

To give you a clean, intact, waterproof ear that no longer has to be protected from water
To reduce the risk of recurrent infections
To allow you to swim, shower, and get on with life without having to think about your ear

Improving hearing is a possible benefit, but it is not the main reason we operate. Hearing outcomes after surgery are variable. Some people notice a clear improvement, some notice little change, and a small number can end up with hearing that is slightly worse. For this reason I am always upfront with patients that the primary goal of the operation is to give them a safer, drier, more reliable ear, rather than to chase a hearing gain.

There is a separate page on this website with much more detail about the operation itself, what it involves, and what to expect during recovery.

What happens at the appointment?

Coming to see me with a hole in the eardrum is straightforward and nothing to feel anxious about. A typical appointment involves:

A careful conversation about your symptoms and ear history
An examination of the ear under a microscope, which gives a much clearer view than a standard ear examination and lets me see the size, position, and condition of the hole
A gentle clean of the ear if needed (microsuction), which is also useful for treatment if there is any debris or discharge
A hearing test to measure exactly how much, if at all, the hearing has been affected
A tympanometry test, which checks how the middle ear is working
Occasionally a scan, particularly if there is anything to suggest cholesteatoma or another underlying problem

By the end of the appointment you should have a clear understanding of what is going on, what your options are, and a plan you are happy with: whether that is conservative management, treatment of an infection, or planning for surgery.

When should you come and see me?

It is worth booking an appointment if:

You have been told you have a hole in the eardrum and want a clear plan
You are getting repeated ear infections or discharge
Your hearing has changed
You are tired of having to keep the ear dry all the time
You are a swimmer, diver, or in a job where you need a reliable, waterproof ear
You simply want a thorough assessment and to understand your options

A hole in the eardrum is rarely an emergency, but it is something that benefits from being assessed properly so you know what you are dealing with and what your choices are.

Helpful resources

Disclaimer

This page is intended as general information only. It does not replace a consultation, examination, hearing assessment, or individual medical advice. If you would like to discuss a hole in your eardrum, please get in touch to book an appointment so I can examine your ear properly and give you advice specific to your situation.

I have no financial interest in any of the products mentioned on this page. They are simply options that I and my patients have found helpful, and there are many other reasonable alternatives.