Ask the Pharmacist

Q: I just felt a sudden, sharp pain in my ear followed by some pus-like liquid flowing down my cheek. What’s gone wrong now?

A: This sounds like a perforated or ruptured ear drum which is a fairly common occurrence that can be quite painful. When this occurs, you really should take steps to ensure that this is just a couple of weeks of hassle rather than potentially a lifetime of partial hearing loss.

A perforated ear drum is essentially a tiny tear in the thin membrane (known as the tympanic membrane) that separates the outer ear from the inner ear. This membrane is made up of a thin tissue that closely resembles skin.

It has two absolutely essential functions. One is to vibrate when sound waves enter your ear and in doing so, pass these vibrations to the small bones that lie behind it in the middle ear. This begins the process of sending signals to your brain that result in your ability to hear. Its other main function is to act as a barrier to the middle ear so that bacteria, water and other foreign objects cannot contaminate the normally sterile inner ear.

Given its functions, it is not too surprising that one of the symptoms of a perforated drum can be hearing loss that is either partial or complete in the affected ear. Others may hear air coming out of their ear when they blow their nose. Other possible symptoms include sudden sharp pain or pain that had been ongoing for days that spontaneously stops, drainage from the ear that may be bloody, clear or pus-like (these first two, in this particular order, are the “hallmark” signs), facial weakness or dizziness and ear noise or buzzing.

There are a number of possible reasons why your eardrum might suddenly perforate. Infections, especially in children, are one of the most common reasons, as fluid accumulates as a result of the inflammation, and this fluid can eventually push against the membrane causing it to tear.

Pressure changes from a flight, scuba-diving, or a shock wave can also be a cause as can direct trauma to the ear from a blow, such as may occur in sports, fights or car accidents. Another possible cause is acoustic trauma which occurs when the ear has been exposed to an extremely loud noise, such as an explosion. Unfortunately, an all-too-common and completely preventable cause is the insertion of a foreign object into the ear such as a Q-tip or fingernail.

Regardless of cause, the first step is to follow up with your physician in order to confirm the diagnosis. Your doctor will likely do an otoscopic exam in which he/she will look into your ear with a lit instrument.

Other possible diagnostic tests include testing any fluid discharge for bacteria, an audiology exam for hearing loss, and tympanometry which tests your eardrum’s response to pressure changes.

Once the diagnosis has been confirmed, adequate precautions must be taken to hasten the healing process. These steps include not blowing your nose any more often or forcefully than is absolutely necessary. The increased pressure caused by this can be both painful and slow the eardrum’s healing.

For the same reasons, try to avoid flying over the next eight weeks if at all possible. While the eardrum is healing, it is also vital to keep it dry, as failure to do so will greatly increase the risk of infection which can complicate the recovery. That means no swimming or diving and the use of a shower cap/ear plugs to keep out water from a shower.

There is no specific treatment for a ruptured eardrum. The vast majority of them will heal naturally within three months as long as the precautions listed above are followed.

If the eardrum is slow to heal, you may be referred to an ENT (ear, nose, throat) specialist who may place a patch over the eardrum or perform a surgery in which a piece of your own tissue is grafted over the tear. This surgery takes a few hours and is done on an outpatient basis.

All in all, while a punctured eardrum can be very alarming when it occurs, the long-term prognosis is very good and the vast majority of patients will be as good as new within a few months.

For more information about this or any other health-related questions, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination. Also check the website at www.gordon-pharmasave.com/ and the Facebook page at www.facebook.com/GordonPharmasave/?fref=ts