A perforated eardrum (tympanic membrane perforation) is a hole in the eardrum. It can be caused by infection (otitis media), trauma, overpressure (loud noise), inappropriate ear clearing, and changes in middle ear pressure. An otoscope can be used to view the eardrum to diagnose a perforation. Perforations may heal naturally, or require surgery. Presentation
A perforated eardrum leads to conductive hearing loss, which is usually temporary. Other symptoms may include tinnitus, ear pain, vertigo, or a discharge of mucus. Nausea and/or vomiting secondary to vertigo may occur. Causes
A perforated eardrum can have one of many causes, such as:

infection (otitis media). This infection may then spread through the middle ear, and may reoccur. trauma. This may be caused by trying to clean ear wax with sharp instruments. It may also occur due to surgical complications. overpressure (loud noise or shockwave from an explosion). inappropriate ear clearing. flying with a severe cold, due to changes in air pressure and blocked Eustachian tubes resulting from the cold. This is especially true on landing. Diagnosis
An otoscope can be used to look at the ear canal. This gives a view of the ear canal and eardrum, so that a perforated eardrum can be seen. Tympanometry may also be used. Treatment
Conservative management
A perforated eardrum often heals naturally. It may heal in a few weeks, or may take up to a few months. Surgery
Some perforations require surgical intervention. This may take the form of a paper patch to promote healing (a simple procedure by an ear, nose and throat specialist), or surgery (tympanoplasty).
Emicizumab (trade name Hemlibra) is a humanized bispecific antibody for the treatment of haemophilia A, developed by Genentech and Chugai (a subsidiary of Roche). A Phase I clinical trial found that it was well tolerated by healthy subjects.In November 2017, it was approved in the United States for treatment of haemophilia A in those who had developed resistance to other treatments. It was subsequently approved by the US FDA in April 2018 under the breakthrough therapy designation for treatment of haemophila A in those who have not developed resistance to other treatments. The U.S. Food and Drug Administration (FDA) considers it to be a first-in-class medication. Mechanism of action
Emicizumab binds to both the activated coagulation factor IX and to factor X, mediating the activation of the latter. This is normally the function of coagulation factor VIII, which is missing in haemophilia A patients. References
External links
"Emicizumab". Drug Information Portal. U.S. National Library of Medicine.