Background: Tympanic membrane perforations are common and can be categorised into either acute or chronic. Acute perforations are usually traumatic or inflammatory in origin and heal spontaneously. Chronic perforations may be associated with underlying progressive disease.
Objective: To differentiate between safe and unsafe perforations and describe management principles for these conditions.
Discussion: The majority of acute tympanic membrane perforations heal spontaneously. Those that do not can be considered for surgical repair. Chronic perforations should be viewed as either safe or unsafe depending on the risk of progression to significant complications. Unsafe perforations are often associated with cholesteatoma (an epidermoid cyst of the middle ear and mastoid air cell system). Cholesteatoma destroys bone and causes serious ear and intracranial complications--surgery is commonly required.
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