Tinnitus from a perforated eardrum usually fades as the eardrum heals, which for most traumatic perforations takes weeks: in one study, spontaneous healing averaged 26.8 days, from about 12.6 days for small perforations to 38.4 for large ones.
A perforated (ruptured) eardrum is a physical disruption to how sound reaches the inner ear — a more sudden version of the conductive problem covered in the article on earwax and tinnitus — with its own, generally reassuring recovery pattern.
When to see a doctor
See a doctor promptly after a suspected perforation — sudden ear pain, or a pain that suddenly eases, with muffled hearing, ringing or bleeding — so the eardrum can be examined and your hearing checked.
Go the same day if the injury also brings spinning dizziness, or hearing loss that is severe or keeps getting worse. In most people these settle: in one study of 198 patients with traumatic perforations, vertigo was reported by 8.1% at first and by none at follow-up. But they can mean the inner ear has been affected rather than only the eardrum, and a leak of inner-ear fluid after head trauma or a pressure injury — a perilymph fistula — can be corrected surgically by sealing the leak.
Contact a doctor sooner than planned if discharge appears while it heals, and ask about surgical repair if the perforation, hearing loss or tinnitus is still there after about two months.
What causes it, and how tinnitus fits in
The eardrum can rupture from a range of causes: direct trauma (a cotton swab pushed too far, a slap to the ear), sudden pressure changes (explosions, diving, a hard sneeze while the nose is blocked), loud blast noise, or as a complication of a severe ear infection. Common symptoms include sudden ear pain or sudden relief from a pain that was already there, some hearing loss in the affected ear, possible bleeding or discharge, and ringing in the ear. Explosive or blast-related trauma specifically is described as commonly producing tinnitus lasting several days alongside the hearing loss.
In the 198-patient study, from Germany's largest university ear, nose and throat clinic, the typical patient was young (mean age 29.2) and male (62%). A blow to the ear was the commonest cause for both sexes, and a perforation from a cotton bud was roughly twice as common in women as in men.
How long healing takes, with real numbers
Most perforated eardrums heal on their own, without any procedure. A study specifically measuring healing time by perforation size found spontaneous healing averaged 26.8 days overall — but varied considerably by size: small perforations closed in about 12.6 days on average, medium ones in about 21.8 days, and large perforations took closer to 38.4 days. The same study found a Gelfoam patch (a dissolvable material placed over the perforation to support healing) meaningfully sped this up across all sizes — down to an overall average of 14.7 days, roughly half the time — with a 90.4% spontaneous closure rate versus 94.5% with the patch by 3 months (a difference the study found was not statistically significant, meaning the patch mainly helps you heal faster, not more completely).
A 2022 systematic review of 24 studies, covering 2,796 ears with traumatic perforations, puts that single study in context. Complete healing without patching ranged from 67% to 97% across the studies, and was 92–93% with a paper patch. The reviewers found the two approaches had similar success rates, with healing slightly quicker after patching in their own patients, and recommended considering patching first because it is a simple office procedure.
What the research shows about the ringing
Tinnitus tied to a perforated eardrum is a symptom of the physical disruption itself, not a separate, independent process, so as the perforation closes and normal eardrum function returns, tinnitus tied to it typically resolves alongside the hearing changes. This is a different pattern from most causes of tinnitus, where the underlying mechanism (noise-induced hair cell damage, for instance) doesn't reverse once healing is complete.
The 198-patient study measured it directly. Tinnitus was reported by 30.8% of patients at first, and by 2.0% at follow-up. Hearing told the same story: hearing through bone conduction, which reflects the inner ear rather than the eardrum, was worse in the injured ear at high frequencies at first, and the difference was no longer significant at follow-up. The authors' conclusion is that high-frequency hearing loss, tinnitus and vertigo after a traumatic perforation have a good prognosis.
When it's not just "wait it out"
Most small-to-medium perforations close on their own within about two months without needing anything beyond keeping the ear dry and avoiding further trauma. If a perforation hasn't closed after two months, a procedure called tympanoplasty — surgical repair of the eardrum — is generally recommended and has a high success rate.
One thing worth knowing before surgery is that the operation can leave tinnitus of its own, and how often depends on who is asked. Sweden's national registry for myringoplasty (surgical repair of the eardrum) recorded tinnitus a year after the operation in 1.2% of patients when doctors reported it, and in 12.3% when patients reported it themselves. Where it occurred, it tended to persist over a long period. Tinnitus after ear surgery covers this in more detail. It is a reason to ask the question, not a reason to avoid a repair that is needed.
While it heals
- Keep the ear completely dry during healing — water exposure is one of the most common things that slows or prevents a perforation from closing on its own
- Don't put anything in the ear canal while it's healing, including cotton swabs
- Ringing that started right when the perforation happened is expected and usually temporary — it's reasonable to expect it to ease as the eardrum itself heals, typically within the same few-week window
- If hearing loss, drainage, or tinnitus persists well past two months, that's the point to ask specifically about tympanoplasty rather than continuing to wait