Tympanic membrane perforations are usually caused by an internal source such as a middle ear infection. In response to a true middle ear infection, many times the fibers of the tympanicmembrane will open up to allow the pus to drain to the outside world. Great majority of these perforations will spontaneously heal and do not require surgical management. At times an office procedure could be used to facilitate the healing of these perforations. In patients who develop numerous episodes of middle ear infections, sometimes these perforations will become permanent and need to be surgically treated.
The perforations that are caused by an external source such as Q-tips and other forms of foreign objects rarely heal spontaneously. The reason is that the outer layer of the tympanic membrane which is squamous epithelium is folded into the middle ear and will not allow the perforation to heal. These perforations should be treated by an expert surgeon. Please refer to surgical section under tympanoplasty for details of the surgery.