eardrum, ruptured

If your child has an earache and suddenly a white or yellow pus-like fluid appears to drain from the ear canal, probably your child has suffered a ruptured eardrum (tympanic membrane) from a middle ear infection (otitis media). This runny ear (otorrhea) is nature's way of relieving pressure on the sensitive inner ear structures and resolving the infection. Before the advent of antibiotics for ear infections, this was the way many ear infections were cured - naturally.

In fact, it is the way most of my earaches ended, since I grew up in the pre-antibiotic era.

While the prospect sounds perhaps a little frightening to parents, natural tearing or rupture of the eardrum in this way is totally benign. The eardrum tears along the bottom edge, the pus drains out, and the eardrum heals in a few days with no trace of a scar and totally normal function.

The ability of the eardrum to heal without complication or major scarring often led doctors in the "old days" to use a tiny knife to slit the eardrum (tympanocentesis) to relieve the pressure and pain. This cured the infection; sometimes they obtained a bacterial culture of the pus to identify the germ involved. This practice, which fell by the wayside to such a degree that very few pediatricians have ever done the procedure, may be coming back into use again because of the dramatic rise in antibiotic resistance of common middle ear disease bacteria.

Not so benign is a ruptured eardrum caused by a blow to the ear, as with the palm of an open hand, forcible insertion of a foreign object such as a twig or a pencil, or caused by a gunshot report next to the ear. I have seen both of these events in my practice. Such trauma to the ear can leave the ear bones (ossicles) dislocated and incapable of carrying sound properly until they are microsurgically relocated. Blood from the ear canal, decreased hearing or persistent ringing in the ear after direct trauma to the ear should prompt immediate ear specialist (otorhinolaryngologist) examination.

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