Most small perforated eardrums heal on their own within three to six weeks. Larger perforations can take several months, and some don’t close without surgery. The timeline depends mainly on the size of the hole, its location on the eardrum, and whether the ear stays dry and infection-free during recovery.
Healing Timeline by Perforation Size
A small perforation, the kind most commonly caused by a sudden pressure change or a minor injury, typically closes within three to six weeks. The eardrum is a thin, three-layered membrane, and when the hole is small, the outer skin layer can migrate across the gap relatively quickly. Medium perforations often take six to eight weeks, while large ones may need three months or longer to fully seal.
What makes eardrum healing unusual compared to, say, a cut on your arm is that the membrane has air on both sides. There’s no underlying tissue to act as scaffolding for new cells. Instead, the outer skin layer has to grow across an open gap, which is why the process is slower and more fragile than typical wound healing. The body first forms a thin layer of granulation tissue (similar to the pink tissue you see in a healing scrape), and then skin cells gradually spread inward from the edges of the hole until it closes.
How Much Hearing Loss to Expect
A perforated eardrum causes conductive hearing loss, meaning sound vibrations can’t transfer as efficiently to the inner ear. The amount of hearing loss tracks closely with the size of the hole. Small perforations cause an average loss of about 32 decibels, roughly equivalent to putting a finger loosely over your ear. Medium perforations average around 36 dB of loss, large ones about 40 dB, and near-total perforations reach about 42 dB. The loss rarely exceeds 50 dB regardless of size.
Hearing typically returns to normal once the eardrum closes completely. If you notice your hearing isn’t improving even after the perforation has healed, that can indicate damage to the tiny bones behind the eardrum or another issue worth getting checked.
What Affects How Fast You Heal
Several factors speed up or slow down recovery. Perforations in the center of the eardrum tend to heal faster than those near the edges, because the skin layer migrates more evenly from all directions. A “dry” perforation, one without active drainage or infection, heals significantly better than a “wet” one. Pre-existing scarring or calcium deposits on the eardrum (common in people who’ve had repeated ear infections) can also interfere with the healing process.
The cause of the perforation matters too. A clean traumatic tear from a pressure change or a minor poke tends to heal more predictably than a perforation caused by chronic infection, which may have damaged the surrounding tissue.
Protecting Your Ear While It Heals
The single most important thing you can do is keep the ear dry. Water entering the ear canal can introduce bacteria and disrupt the fragile new tissue growing across the hole. When you shower or bathe, use waterproof earplugs or a cotton ball coated with petroleum jelly to seal the opening. Swimming is off the table until the perforation has fully closed.
You should also avoid blowing your nose, or at least do so very gently with your mouth open. Forceful nose-blowing pushes air up through the tube connecting your throat to your middle ear, which can push against the healing membrane or force bacteria into the middle ear space. For the same reason, avoid any activity that creates sudden pressure changes in the ear, like diving or, ideally, flying.
Resist the urge to clean inside your ear, even gently. Cotton swabs or other tools can physically disturb the new tissue forming across the perforation and restart the healing clock.
When Surgery Becomes Necessary
If a perforation hasn’t closed on its own after about three months, or if it’s large enough that spontaneous healing is unlikely, a surgical repair called tympanoplasty is the next step. The procedure uses a small graft, usually taken from tissue near the ear, to patch the hole.
Success rates vary depending on the technique and the complexity of the case. Endoscopic approaches, which use a tiny camera inserted through the ear canal, show closure rates around 85%. Microscope-assisted techniques, which are more traditional, tend to have lower success rates. Across institutions, graft survival tends to be highest in the first few months after surgery and can decline somewhat over time. One large study found grafts intact in about 84% of patients at one month, dropping to around 73% at twelve months.
Recovery from tympanoplasty usually involves a few weeks of keeping the ear dry and avoiding strenuous activity. Most people notice hearing improvement within the first month, though full healing of the graft can take two to three months.
Signs That Healing Isn’t Going Well
Some symptoms are normal during recovery. Mild, intermittent ear pain, a feeling of fullness, and reduced hearing are all expected and should gradually improve. What’s not normal is worsening pain after the first few days, new drainage (especially if it’s thick, discolored, or foul-smelling), fever, or hearing that gets worse instead of better. These suggest a secondary infection in the middle ear, which can stall healing and may need treatment with antibiotic ear drops.
If your perforation was caused by a blast injury, a deep object penetration, or severe infection, the risk of complications is higher. Persistent perforations that repeatedly get infected can, over years, lead to a growth of skin cells into the middle ear space, which requires more involved surgical treatment. This is rare with a straightforward traumatic perforation that’s properly cared for.