People can develop a perforation in the eardrum for a variety of reasons. These include chronic ear infections or trauma to the ear, such as from a blow to the head or from injuring the eardrum with an object such as a cotton swab. Water entering the middle ear space through a perforation may result in infection, pain and drainage. More sizeable holes can also lead to hearing loss. Some perforations close without treatment, but in other cases surgical procedures are necessary. Repair of perforations may be performed by an otolaryngologist in the office using paper patches or other techniques to repair the eardrum. If these are not successful a tympanoplasty, or a more extensive surgical repair of the eardrum, may need to be performed in the operating room.