Inflammation of the eardrum

The eardrum, also called the tympanic membrane, is a thin membrane that separates the outer ear canal from the middle ear. In addition to protecting the middle ear, the main function of the eardrum is to transfer sound waves to the inner ear, where the cochlea (the organ of hearing) is located.

An acute inflammation of the eardrum – which doctors refer to as myringitis – causes pain and fever and can be associated with hearing difficulties. This type of inflammation frequently occurs in conjunction with a middle ear infection. It is caused by viruses or bacteria. 

Symptoms can be relieved with pain medication and, in the case of a bacterial infection, with antibiotics. However, they usually disappear on their own after a couple of days. Serious complications are rare. 

A chronic inflammation tends to be milder in nature. Pain is rare but there is discharge from the outer ear canal (referred to by doctors as a “draining ear”). The causes of a chronic inflammation are unclear. 

The typical symptoms for an acute inflammation of the eardrum are: 

• sudden earache
• impaired hearing in some cases – due to a build-up of fluid in the middle ear: this usually occurs as a result of an accompanying middle ear infection
• fluid-filled or blood-filled blisters on the outer side of the eardrum
• possibly fever

In addition, an acute inflammation of the eardrum is almost always accompanied by a middle ear infection.

Inflammation of the eardrum is considered to be chronic if the symptoms persist for at least one month. Chronic inflammations are usually mild. Possible symptoms include earache, itching and ear pressure. There is sometimes a discharge of fluid from the ear, referred to by doctors as draining ear or otorrhea. Without treatment, further pathogens may become established, leading to re-infection or tears in the eardrum. 

Various viruses or bacteria can cause an acute inflammation of the eardrum. These are typically the same pathogens that cause an acute middle ear infection. 

The precise cause of a chronic inflammation of the eardrum is unclear. Experts assume that certain external factors cause damage to the eardrum – for example, it may be damaged if cotton swabs are used to clean inside the ear. Surgical procedures on the ear may also be a potential cause.

Inflammation of the eardrum is relatively rare.

Research indicates that, every year, approximately 6% of children under the age of 2 suffer an acute inflammation of the eardrum. Boys are affected more often than girls. 

In adults, inflammation of the eardrum seems to be more common among women than men.

With an acute inflammation of the eardrum, the pain usually disappears on its own within 3 days. A discharge from the ear may persist for a number of weeks, even if the eardrum is no longer inflamed. The inflammation generally clears up completely.
 
People with a chronic inflammation of the eardrum have symptoms for at least a month. During this time, there will be phases when they have discharge from the ear and feel pressure in the ear, as well as phases when the symptoms disappear. Hearing loss may occur if they suffer repeated inflammations. 

A doctor will begin by asking about the acute symptoms and any prior history of the illness – such as whether the patient has previously had any other problems with their ears. This is followed by a physical examination.

The doctor uses an otoscope (also called an auriscope) to detect any inflammatory changes to the eardrum. They can also determine whether the patient has a middle ear infection and whether the inflammation of the eardrum is acute or chronic. This will determine what treatment is to be administered.

In case of doubt, imaging techniques such as computed tomography (CT) can help doctors make a correct diagnosis – but these are rarely required. A hearing test helps establish whether the patient is suffering from hearing loss. A test may also be performed to determine which pathogen has caused the infection.

An acute inflammation of the eardrum is treated with: 

• pain medication
• anti-inflammatory medication
• decongestant nasal drops
• antibiotics if the inflammation is due to a bacterial infection

Decongestant nose drops improve the ventilation of the middle ear. It is recommended that these drops only be used for a few days because they can damage the mucus lining inside the nose. Antibiotics can be taken in the form of ear drops or swallowed as tablets. They are sometimes prescribed in combination with anti-inflammatory steroids. 

The doctor may break open blisters on the eardrum with a small knife. This relieves the pain, as it stops the tissue from being stretched. 

Antibiotics are the first choice for treating a chronically inflamed eardrum – provided that the cause is a bacterial infection. However, symptoms often re-appear after this type of treatment. 

If the inflammation continues to recur despite treatment with medication, doctors may treat a chronic inflammation of the eardrum with a carbon dioxide laser. This removes the inflamed tissue layer by layer.

If this treatment isn’t sufficiently effective, the inflamed part of the eardrum can be surgically removed and replaced by a membrane made of artificial material.