The causes of perforated eardrum are usually from trauma or infection. A perforated eardrum can occur: If the ear is struck squarely with an open hand, with a skull fracture, after a sudden explosion, if an object (such as a bobby pin, Q-tip, or stick) is pushed too far into the ear canal. As a result of hot slag (from welding) or acid entering the ear canal Middle ear infections may cause pain, hearing loss, and spontaneous rupture (tear) of the ear-drum resulting in a perforation. In this circumstance, there maybe infected or bloody drainage from the ear. In medical terms, this is called otitis media with perforation. On rare occasions a small hole may remain in the eardrum after a previously placed PE tube (pressure equalizing) either falls out or is removed by the physician. Most eardrum perforations heal spontaneously within weeks after rupture, although some may take up to several months. During the healing process the ear must be protected from water and trauma. Those eardrum perforations which do not heal on their own may require surgery.