Most ruptured eardrums heal on their own within one to four months without surgery. Your main job during that time is to keep the ear dry, manage pain, and avoid anything that could slow healing or cause infection. Here’s what to do right now and what to expect in the weeks ahead.
Keep Your Ear Dry
Water entering the middle ear through the hole in your eardrum is the single biggest risk for infection during healing. Every time you shower, bathe, or wash your hair, place a waterproof silicone earplug or a cotton ball coated with petroleum jelly in the outer ear. The petroleum jelly creates a water-resistant seal that a dry cotton ball alone won’t provide. Keep this up until a doctor confirms the perforation has closed.
Swimming and submerging your head are off-limits until the eardrum has fully healed. Even shallow water can push bacteria into the middle ear space.
Managing Pain at Home
The sharp pain from a rupture usually fades within the first day or two, but a dull ache can linger. Over-the-counter pain relievers like acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve) all work well. Don’t combine two pain medicines that both contain acetaminophen, since too much can damage your liver.
A warm washcloth or a heating pad set on low, held against the outer ear, can ease discomfort between doses. Do not put anything into the ear canal: no drops, no cotton swabs, no home remedies. Inserting objects risks further tearing the membrane or introducing bacteria.
Ear Drops Can Be Dangerous
This is one of the most important things to know. When your eardrum is intact, it acts as a barrier protecting the delicate structures of the middle and inner ear. With that barrier broken, certain ear drops can pass straight through and cause permanent hearing damage.
Drops containing alcohol, those with a low pH (acidic formulas), and drops with aminoglycoside antibiotics (a class found in some common prescription ear drops like neomycin combinations) should not be used with a perforated eardrum. The manufacturer of neomycin/polymyxin B/hydrocortisone drops explicitly warns against use with a non-intact eardrum because of the risk of permanent hearing loss. The only topical antibiotics the FDA has approved for use in a middle ear exposed by a perforation are fluoroquinolone drops, which your doctor can prescribe if an infection develops.
The bottom line: don’t use any ear drops unless a doctor who knows about your rupture has specifically prescribed them.
What Healing Looks Like
Small perforations from acute causes, such as an infection, a sudden pressure change, or a poke from an object, typically close on their own within one to four months. During that time you may notice reduced hearing in the affected ear, occasional mild drainage, and a feeling of fullness. Hearing gradually improves as the membrane regrows across the hole.
Your doctor will likely schedule a follow-up to check progress. If the perforation hasn’t closed after a few months, or if it’s large, surgical repair becomes an option.
When Surgery Is Needed
The procedure to repair a perforated eardrum is called tympanoplasty. It involves placing a small graft, often taken from tissue near the ear, over the hole to act as a scaffold for new growth. The surgery successfully closes the perforation in 75 to 90 percent of cases, according to Johns Hopkins Medicine. For smaller holes, a doctor may first try a simpler in-office approach: placing a thin paper or gel patch over the perforation to encourage the membrane to heal on its own.
Surgery is more likely to be recommended when the tear is large, located at the edge of the eardrum, or has persisted for several months without signs of closing. Recovery after tympanoplasty generally means keeping the ear dry and avoiding heavy exertion for several weeks. Your doctor will let you know when it’s safe to resume normal activities, including flying.
Flying and Pressure Changes
Counterintuitively, flying with a perforated eardrum is generally safe and may actually cause less discomfort than flying with intact eardrums. The hole allows air pressure in the middle ear to equalize more easily with cabin pressure, so you’re less likely to feel that painful “plugged” sensation during takeoff and landing. However, if you’ve had surgical repair of the eardrum, you should not fly until your surgeon clears you.
Risks of Leaving It Untreated
Most perforations heal without complications, but ignoring one that isn’t closing carries real risks. Repeated exposure to water or bacteria through an open perforation can lead to chronic middle ear infections. Over time, a long-standing perforation can also lead to a cholesteatoma, a growth of dead skin cells that collects behind the eardrum and forms a cyst-like mass. Cholesteatomas can become infected and, without treatment, grow large enough to damage hearing and the facial nerve.
Persistent hearing loss is the other concern. The eardrum vibrates to transmit sound, and a hole disrupts that vibration. The larger the perforation, the greater the hearing loss. If your hearing hasn’t returned to normal after a couple of months, or if you notice worsening drainage, increasing pain, or dizziness, those are signs the perforation needs medical attention rather than more time.