Injury Profiles: Ruptured Eardrum

Happy New Year and welcome back to Mangled Mondays, where every Monday we talk about another facet of maiming, mangling, mauling, and mistreating your main characters — and all of their friends. 

Today we’ll be talking about Ruptured Eardrums. For the rest of the Mangled Mondays series, [click here].

Ruptured Eardrum

Lethality Index


What Is It?

A ruptured eardrum is exactly what it says on the tin: an eardrum that’s burst.

The eardrum, or tympanic membrane, is a thin layer of tissue between the ear canal itself and the middle ear, where we begin to process sound.  It protects the sensitive inner ear from damage.

When it’s ruptured, the eardrum can no longer effectively transmit clear sound to the inner ear. The character may hear a significant ringing sound, and may lose some or all hearing in the ear for some time.


Clinical Signs:

  • Blood or clear fluid draining from the ears.
  • With otoscope: visible tear or rupture of the tympanic membrane.



  • Severe pain before and during rupture; may be painless afterward.
  • Hearing loss (partial or complete).
  • Buzzing or ringing sound in the ear; may hear whistling when sneezing or blowing the nose after the tear.

How Does It Happen?

There are two main causes of tympanic rupture.

The first is direct trauma. This is typically inadvertent, when the character digs too deep with a Q-tip, though because we are authors and thus inherently evil, it’s also possible for this to be a deliberate attack or form of torture by a villain using anything from a Q-tip or toothpick to the tip of a thin knife or scalpel.

The second cause is pressure. Severe ear infections can build up enough pressure to rupture the membrane – this is exceedingly painful – but other forms of excess pressure can cause it too. Rapid ascent from a dive is a plausible cause; . and, especially when added to the increased pressure resulting from ear or sinus infection or congestion, so is rapid altitude change on a flight or in an elevator. Pressure injuries are known as barotrauma.

Barotrauma can also be a side effect of an explosion, where pressure builds up quickly enough to rupture the eardrum. This is known as a primary blast injury, because the injury is from the pressure wave (as opposed to the shrapnel, the character being thrown, or subsequent trauma from causes related to the explosion).


Immediate Treatment


Immediate care for a ruptured tympanic membrane is supportive; that is, the symptoms are cared for, but not the injury itself. If there’s dirt or debris in the ear, characters might flush it out with saline solution (salt water).

Definitive Treatment

Surgery / Hospitalization

Tympanic ruptures are typically left to heal on their own. Extreme ruptures can be repaired with a piece of paper surgically attached to the eardrum, which provides a scaffold for the eardrum to heal on. This procedure is outpatient and the character will be awake for it, but the ear will be well anesthetized.


In the Austere Environment

There is nothing to be done. The ear will heal on its own.

The Rocky Road to Recovery

Capabilities Retained

Cognition and limb motion are unaffected. Vision is unaffected.


Disabilities: Temporary

Characters may experience trouble with balance during healing. Hearing loss is significant but often not complete, and is temporary. Speech may be slightly uncoordinated and louder because of the character’s difficulty hearing their own speech.


Disabilities: Permanent

Depending on the circumstances, the character may experience some permanent hearing loss.


Features of Recovery: Hospital Stay



Features of Recovery: PT/OT


The New Normal

The eardrum will heal in about 2 weeks, and the character’s hearing will be restored, either completely or partially.


Future Risks

Your character will be at elevated risk for future tympanic rupture.

Total Recovery Time (Typical)

2 weeks



Blood, or clear fluid similar to mucus, coming from the character’s ear(s).






Affected character may hear a loud bang, and may continue to hear whining, buzzing, or ringing in their ears.

The character may hear a whistling sound while blowing their nose or sneezing.


The tympanic membrane is often referred to as the TM.

A TM rupture might also be known as a perforation or a TM perf.

Key Points

  • Tympanic rupture produces ringing in, and draining of blood or fluid from, from, the ears.
  • Characters will have partial or complete hearing loss.
  • Hearing should be regained as the eardrum heals, about 2 weeks, but some loss may persist indefinitely.

xoxo, Aunt Scripty


This post is an excerpt from Blood on the Page Volume One: A Writer’s Compendium of Injuries. The book details thirty-one injuries with which to maim, mangle, and maul your characters, as well as nine indispensable articles of Wound Wisdom covering everything from burn stages to suture selection.

Print and digital editions are available on [Amazon], and digital editions are available [everywhere else].