My Child Has a Perforated Eardrum — Will It Heal? A Parent’s Guide
Being told that your child has a perforated eardrum can sound more alarming than it often is.
Parents may hear terms such as “burst eardrum”, “hole in the eardrum” or “tympanic membrane perforation”. Sometimes the diagnosis follows a painful ear infection that suddenly starts discharging. In other cases, the hole is found after an injury, loud noise, pressure change or hearing test.
The first question is usually:
“Will it heal?”
In many children, the answer is yes.
NHS guidance explains that a perforated eardrum is a hole or tear in the eardrum and that it commonly heals on its own, often within around two months.
However, not every perforation behaves in exactly the same way. The cause, size and position of the hole, whether infection keeps recurring and whether hearing is affected all influence what happens next.
This guide explains what parents need to know, including water precautions, hearing assessment, when surgery may be considered and which symptoms deserve urgent attention.
What exactly is the eardrum?
The eardrum, or tympanic membrane, is a very thin membrane at the end of the ear canal.
Sound waves travel through the ear canal and make the eardrum vibrate. These vibrations are then transmitted through the tiny middle-ear bones towards the inner ear.
The eardrum therefore has two important roles:
- helping transmit sound
- forming a protective barrier between the ear canal and middle ear.
A perforation means that there is an opening in this membrane.
ENT UK describes eardrum holes as perforations and notes that they can vary considerably in size.
Why does a child’s eardrum perforate?
One of the most common causes in children is an acute middle-ear infection.
During an ear infection, inflammatory fluid or pus can build up behind the eardrum. Pressure increases and, occasionally, the eardrum develops a small hole through which the fluid drains.
Current Hertfordshire and West Essex paediatric guidance explains that when this happens, pus may run from the ear and the earache can actually improve because the pressure behind the eardrum has been released.
Other possible causes include:
- an object pushed into the ear
- cotton-bud injury
- a blow to the ear
- sudden very loud noise
- significant pressure change
- previous ear surgery or grommets
- chronic middle-ear disease.
NHS guidance similarly identifies infection, injury, loud noise and sudden pressure change as recognised causes.
How would I know my child’s eardrum has burst?
Sometimes the pattern is quite characteristic.
A child may have significant ear pain during an infection and then suddenly develop fluid or pus coming from the ear, while the pain becomes less severe.
Other symptoms can include:
- muffled hearing
- blood-stained discharge
- earache
- ringing or buzzing
- dizziness
- itching
- fever if infection is present.
NHS lists hearing loss, tinnitus, ear pain, discharge and dizziness among possible symptoms of a perforated eardrum.
However, ear discharge can have several causes, including outer-ear infection and grommet-related discharge. A doctor should confirm the diagnosis by examining the ear.
Is ear discharge after an infection always dangerous?
No.
Ear discharge from an acute middle-ear infection that perforates the eardrum is a recognised childhood presentation.
It does not automatically mean permanent damage.
In many cases, once the infection settles, the perforation closes spontaneously.
NICE guidance on acute otitis media recognises perforation and ear discharge as part of the clinical spectrum of middle-ear infection.
The important issue is whether the discharge settles and whether the eardrum heals afterwards.
Will a perforated eardrum heal on its own?
Often, yes.
NHS guidance states that perforated eardrums usually recover without treatment within around two months.
A more recent NHS paediatric leaflet from Kingston and Richmond recommends checking the ear again around 6–8 weeks after a perforation associated with acute otitis media to confirm that healing has occurred.
Healing may depend on:
- the size of the perforation
- where it is positioned
- whether the ear remains infected
- whether water repeatedly enters the ear
- whether there has been previous chronic ear disease.
Small traumatic or infection-related perforations often close well. Persistent perforations require further assessment.
Does a perforated eardrum affect hearing?
It can.
A hole changes the way the eardrum vibrates, so sound transmission may become less efficient.
The degree of hearing loss varies. A small perforation may have very little noticeable effect, while a larger hole may produce more obvious conductive hearing loss.
ENT UK notes that larger perforations can reduce hearing and that recurrent infections may also occur.
If your child:
- asks for the television louder
- keeps saying “what?”
- struggles at school
- turns one ear towards you
- has persistent hearing difficulty after the infection has settled
then an age-appropriate hearing test is useful.
Should my child have a hearing test?
A hearing test is particularly helpful if:
- the perforation has not healed
- there is persistent hearing loss
- the child has recurrent ear infections
- speech or school listening is affected
- there is concern about hearing in the other ear.
Hearing tests can help determine whether the hearing problem is simply related to the perforation or whether another middle-ear or inner-ear problem is contributing.
Can my child swim with a perforated eardrum?
Generally, keep the ear dry while the perforation is healing.
The reason is simple: water entering the ear canal can pass through the hole into the middle ear and trigger infection or discharge.
NHS guidance recommends preventing water from entering the ear while it heals.
For bathing or hair washing, you can sometimes place a cotton-wool ball coated with petroleum jelly gently at the outer entrance of the ear to reduce water entry. Do not push it down the canal.
Swimming should usually wait until the ear has healed or until the child’s ENT team has given individual advice.
Can my child fly with a perforated eardrum?
A perforation does not always prevent flying because pressure can equalise through the hole.
However, advice should be individualised if:
- there is active infection
- the child has significant pain
- recent ear surgery has been performed
- there are other middle-ear problems.
After eardrum repair surgery, flying restrictions are different, and families should follow their surgeon’s instructions.
Should I put ear drops into a perforated ear?
Do not use leftover or shop-bought ear drops simply because the ear is discharging.
Some drops are suitable when the eardrum is perforated and others may not be.
NICE prescribing information emphasises using a non-ototoxic preparation when a perforated eardrum is known or suspected.
The type of treatment depends on whether infection is present and what organism or condition is suspected.
If your child has discharge from a known perforation, use only treatment recommended by an appropriate healthcare professional.
Does my child need antibiotics?
Not every perforated eardrum automatically requires antibiotics.
If the perforation occurred during acute otitis media and there is active ear discharge or infection, treatment depends on the child’s age, symptoms, examination findings and clinical severity.
NICE guidance on acute otitis media aims to limit unnecessary antibiotic use because many children recover spontaneously, although certain groups and presentations may benefit from antimicrobial treatment.
The key point for parents is not to assume either that antibiotics are always necessary or that discharge should simply be ignored.
What happens if the perforation does not heal?
A persistent hole can sometimes lead to:
- recurrent discharge
- ear infections after water exposure
- hearing loss
- difficulty swimming comfortably
- ongoing need for water precautions.
ENT UK notes that a persistent hole may cause recurrent infections and discharge, particularly when water gets into the ear.
At this point, an ENT specialist may discuss continued observation versus surgical repair.
What is myringoplasty or eardrum repair?
A myringoplasty is an operation to repair a hole in the eardrum.
It is a form of tympanoplasty focused on reconstructing the tympanic membrane.
ENT UK explains that the repair uses a graft placed against the eardrum. The material may come from tissue around the ear, cartilage/perichondrium or another suitable graft material depending on the surgical technique.
In children, repair is usually performed under general anaesthetic.
The operation is not automatically required just because a perforation exists.
When would surgery be considered?
Surgery may be discussed when a perforation:
- remains open despite adequate healing time
- causes recurrent ear infections
- causes persistent discharge
- significantly affects hearing
- prevents normal water activities
- is associated with other middle-ear disease.
Sheffield Children’s NHS guidance notes that surgery may be suggested for children with recurrent infections related to the perforation or when achieving a waterproof ear is important.
The decision depends on the individual ear and child.
Does repairing the eardrum always restore normal hearing?
No guarantee can be made.
Closing the perforation can reduce infection and create a more protected middle ear, but hearing outcomes depend on more than the eardrum itself.
ENT UK specifically cautions that repairing the eardrum alone does not always produce a major hearing improvement.
If the tiny middle-ear bones or other structures are abnormal, additional factors may affect hearing.
This is why pre-operative hearing tests are important.
What are the risks of eardrum repair?
Families considering surgery should receive an individual consent discussion.
Potential risks can include:
- the graft failing to heal completely
- ongoing perforation
- infection
- bleeding
- temporary dizziness
- altered taste
- tinnitus
- hearing remaining unchanged
- rarely, hearing becoming worse
- very rarely, facial nerve injury.
ENT UK’s myringoplasty information specifically covers these potential outcomes and emphasises that some perforations need no treatment at all.
The aim is shared decision-making based on the child’s symptoms and overall ear health.
When should parents seek urgent medical advice?
Seek prompt medical assessment if your child develops:
- sudden significant hearing loss
- worsening hearing over days
- hearing loss with ear discharge or pain
- severe dizziness
- facial weakness
- severe or increasing ear pain
- high fever with a very unwell child
- swelling or redness behind the ear
- the ear beginning to stick out
- significant head injury.
NHS advises urgent GP or NHS 111 assessment for sudden hearing loss and hearing loss associated with ear pain or discharge.
Swelling behind the ear, severe illness or facial weakness requires particularly prompt assessment because these may indicate a complication rather than a simple perforation.
What if the discharge becomes smelly or keeps coming back?
Persistent or recurrent smelly ear discharge deserves ENT assessment.
A perforation can be associated with chronic middle-ear infection, but recurrent unilateral discharge and hearing loss can also occur with other conditions.
NHS guidance on cholesteatoma lists persistent watery or smelly ear discharge, gradual hearing loss and recurrent infection among common symptoms.
This does not mean that every discharging perforation is a cholesteatoma.
It simply means that chronic or repeatedly discharging ears should not be assumed to be routine.
When should my child see a paediatric ENT specialist?
ENT review may be helpful if:
- the perforation has not healed after the expected period
- there is repeated ear discharge
- hearing remains reduced
- infections recur
- the eardrum cannot be fully assessed
- there is concern about chronic ear disease
- surgery is being considered
- Your child wants to return to regular swimming, but the ear remains open.
An ENT assessment may include microscopic or endoscopic examination of the eardrum and a hearing test.
Paediatric ear assessment in London and Essex
A perforated eardrum can look alarming on examination, but many childhood perforations heal without surgery.
The priority is to allow healing, keep the ear appropriately dry, treat infection when necessary and confirm that hearing and the eardrum recover.
Mr Gaurav Kumar, Consultant ENT Surgeon, assesses children with perforated eardrums, recurrent ear infections, ear discharge, hearing loss and other paediatric ENT concerns across London, East London, Romford, Ilford, Redbridge, Brentwood, Chelmsford and surrounding areas of Essex.
Where a perforation persists, assessment can help determine whether continued observation or repair is the more appropriate option.
The key message for parents
A perforated eardrum in a child often heals naturally.
Many infection-related holes close over several weeks, and NHS guidance indicates that healing commonly occurs within around two months.
While it heals:
- keep the ear dry
- avoid swimming unless advised otherwise
- do not insert cotton buds
- do not use unprescribed ear drops
- arrange follow-up if hearing remains reduced or discharge continues.
If the hole persists, causes repeated infections or affects hearing, paediatric ENT assessment can help determine whether surgical repair should be considered.
Frequently asked questions
Will my child’s perforated eardrum heal itself?
Often yes. NHS guidance says many perforations heal without treatment within around two months.
Can an ear infection burst the eardrum?
Yes. Pressure from infected fluid behind the eardrum can occasionally create a perforation, allowing pus to drain.
Why did my child’s ear pain suddenly improve when discharge started?
If an infected eardrum perforates, pressure behind it can fall when fluid drains, so pain may reduce even though the child still needs appropriate assessment.
Can my child swim with a perforated eardrum?
Usually, keep the ear dry while it heals. Water entering through the perforation can contribute to infection.
Will a perforated eardrum make my child deaf?
It can cause temporary conductive hearing loss, but the effect varies with the size of the hole and the condition of the middle ear.
Does every perforation need surgery?
No. Many heal spontaneously. Surgery is generally considered when a persistent perforation causes recurrent infection, discharge, hearing problems or other difficulties.
What is myringoplasty?
Myringoplasty is an operation that uses a graft to repair a persistent hole in the eardrum.
When should I seek urgent help?
Sudden substantial hearing loss, severe dizziness, facial weakness, swelling behind the ear or a very unwell child warrants prompt medical assessment.
Restore comfort and clear hearing. Contact our friendly London or Essex practice teams today to book a private specialist consultation with Mr Gaurav Kumar.
Disclaimer: This information is intended for general educational and regional SEO purposes only and does not replace personalised clinical advice. For a definitive examination and safe prescription, you need a face-to-face consultation with a registered specialist.
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