A tympanic membrane perforation is a break in the tympanic membrane and the formation of a hole. Most tympanic membrane perforations are caused by infection and trauma. Infections are the main cause of tympanic membrane perforation in children and are most likely to heal spontaneously. Symptoms of tympanic membrane perforation include ear water, mucus or bloody discharge. An ear, nose and throat doctor can confirm a child’s tympanic membrane perforation by first ordering to keep the ear dry and possibly prescribing antimicrobials, anti-congestants and ear drops. A fresh perforation will usually heal spontaneously within a few weeks. In adults, tympanic membrane perforations are usually associated with hearing loss in the affected ear. Water in the ear during showering and swimming can be painful and can also cause vertigo. Recurrent in-ear infections associated with swimming in the summer may be caused by an unprotected tympanic membrane perforation. Most adults who have frequent middle ear infections usually have a history of ear infections from early childhood. Air travel with a severe cold can also result in tympanic membrane perforation due to changes in air pressure, especially during landing. Sudden ear pain and bloody discharge are signs of a perforated tympanic membrane and should be sought as soon as possible. Injury from digging in the ear with cotton swabs or other objects is another common cause of tympanic membrane perforation in adults or children. With topical care and ear abstinence, 93% of perforations will heal spontaneously within 4 weeks. If they do not heal after that time, surgery is required to repair the eardrum, and many otologists wait 2 months after the perforation occurs before they are willing to perform tympanic membrane repair surgery. However, in some cases, a tympanic membrane perforation caused by ear digging may push the skin of the tympanic membrane into the middle ear cavity, so surgical microscopic examination of the perforation is a necessary procedure to prevent complications. If the hearing loss is relatively large, it is likely that there is damage to the auditory bone. The hearing bone lesion can be determined by high-resolution CT. Active middle ear infections that do not reach the dry ear with conventional treatment may indicate inflammation of the mastoid process. The mastoid is the hard bone that we can touch behind the ear. Within this bone is a gas-containing cavity that we call the mastoid cavity, which is connected to the middle ear, which is also filled with gas. An infection in the middle ear cavity can spread to the mastoid cavity and lead to a more serious infection, which we call mastoiditis, and a CT scan is necessary to identify this lesion. Surgical options and results of tympanoplasty: Tympanoplasty is not recommended for all tympanic membrane perforations. Chronic nasal and sinus inflammation or allergies make this procedure more likely to fail, so inflammation of the nose and sinuses must be resolved or controlled prior to surgery. The ear and nose are connected by the eustachian tube, and if there is active inflammation in the nose or sinuses, inflammatory tissue and secretions can obstruct the eustachian tube or even back up into the eustachian tube. Severe allergic reactions can lead to edema of the eustachian tube covered with mucous membrane. Unless the allergy is effectively controlled, the edema will block the eustachian tube and the procedure to repair the tympanic membrane will be a failure. Tympanoplasty is also not recommended in young children, as some children develop ear infections with running water after each cold. This is a controversial topic, however, because perforations left untreated for long periods of time can form cholesteatomas or lead to some degree of high frequency sensorineural deafness. The youngest age of the author’s completed tympanoplasty patients was 9 years old. Overall, the results of tympanoplasty are very satisfactory, especially when a cautious approach and satisfactory measures are taken. It is important to ensure that inflammation is removed prior to surgery, which may require antimicrobial agents as well as weekly outpatient cleanup ear cleaning, and ear surgeons usually predict successful repair of the tympanic membrane in more than 90% of procedures.