Tympanic membrane perforation may be caused by, e.g., trauma or acute or chronic middle ear infection. Perforation causes conductive hearing loss. Since it predisposes to infections, it is important to keep the ear dry. In most cases traumatic perforations heal spontaneously. Perforations caused by acute middle ear infections are treated with antibiotics. Chronic perforation due to chronic middle ear infection or cholesteatoma will usually not heal without surgery. Most perforation cases can be taken care of in primary care. ENT consultation is needed when alarming signs, such as continuous pain, vertigo or facial paralysis exist, or if the perforation persists.