The main clinical factors leading to tympanic membrane perforation are inflammation and trauma. Inflammation-induced tympanic membrane perforation is mainly seen in acute otitis media and chronic otitis media; traumatic tympanic membrane perforation is seen in direct contact injury and also in indirect external forces such as blunt tool (including palm and fist) blow, skull base fracture, explosion injury, inadvertent ear digging, needle prick, scald, insect into the ear, etc. Pathways or causes of tympanic membrane perforation: 1. Middle ear infection caused by the direction of the eustachian tube is the most common pathway in children and has been the most common cause of tympanic membrane perforation in the past. Since the anatomy of the eustachian tube in children is short, wide and straight compared to that of adults, nasal secretions, milk, etc. tend to flow or choke into the middle ear via the eustachian tube. In addition, the immune system of the middle ear in children is not perfect, which makes them prone to acute otitis media, resulting in inflammation of the tympanic membrane, local ischemic necrosis, and thus tympanic membrane perforation. 2. Direct cause: When digging the ear via the external ear canal to remove cerumen or foreign objects, unfamiliarity with local anatomy or unclear vision can damage the tympanic membrane, resulting in tympanic membrane perforation. The tympanic membrane can also be damaged by head trauma, combined with temporal bone fracture, strong water column or airflow spraying the tympanic membrane, mistakenly dropping chemical corrosive into the ear, or splashing metal shavings and slag into the ear canal. 3, indirect causes: the main air pressure impact injury. In wartime, mostly close range shells and bombs explode with loud noise and air waves that can break the eardrum. Daily, slapping can perforate the eardrum. Due to the inaccessibility of the eustachian tube when sitting in an airplane, a drastic change in pressure in the external ear canal when the plane lands can also cause perforation; if the air pressure in the middle ear cavity suddenly rises sharply, an imbalance in air pressure inside and outside the tympanic membrane can also occur, such as blowing the nose with force, resulting in a violent impact of air pressure in the middle ear on the tympanic membrane from the inside out, which can cause the tympanic membrane to rupture and perforate.