Tympanic membrane perforation may result from impact injury or explosive acoustic trauma Spontaneous healing occurs in most cases Persistent perforation may result from secondary infection brought on by exposure to water Patients should be advised to wear earplugs while swimming or bathing during the healing period Hemorrhage behind an intact tympanic membrane (hemotympanum) may follow blunt trauma or extreme barotrauma Spontaneous resolution over several weeks is the usual course When a conductive hearing loss greater than 30 dB persists for more than 3 months following trauma, disruption of the ossicular chain should be suspected Middle ear exploration with reconstruction of the ossicular chain, combined with repair of the tympanic membrane when required, will usually restore hearing