There are two actual causes of tympanic membrane perforation, one is caused by inflammation and the other is caused by trauma, which is a minor injury. When the eardrum is perforated there are the following symptoms: Hearing loss, which can be mild or moderate depending on the size of the perforation. Bleeding from the ear canal, residual tympanic membrane congestion, ear pain and tinnitus. When patients experience these symptoms, they should go to the hospital immediately for prompt examination. There are many causes of trauma to the tympanic membrane perforation, which can be direct or indirect trauma, etc. Direct trauma is caused by a head injury that causes a fracture of the temporal bone, resulting in damage to the eardrum. Another cause, if you dig your ears too hard or get hit by someone while digging, may puncture the eardrum. Indirect trauma causes perforation of the eardrum, which is caused by loud noises, such as rapid aircraft descent and flapping causing perforation of the eardrum. Whatever the cause of the eardrum perforation, it is important to keep the ear dry, do not dig or enter water, do not blow your nose, and consider surgery if the eardrum does not heal after six months.