Infants oftentimes look for their caregivers to give them a sense of comfort and familiarity, which causes separation to become challenging. Subsequently, the concept of object permanence emerges—which is when children learn that something still exists when it cannot be seen or heard, thus increasing their awareness of being separated from their caregiver. Consequently, during the developmental period where an infants sense self, incorporating object permanence as well, the child also begins to understand that they can in fact be separated from their primary caregiver. They see this separation as something final though, and dont yet understand that their caregiver will return causing fear and distress for the infant. It is when an individual (infant, child, or otherwise) consistently reacts to separation with excessive anxiety and distress and experiences a great deal of interference from their anxiety that a diagnosis of separation anxiety disorder (SAD) can be warranted.One of the difficulties in the identification of separation anxiety disorder in children is that it is highly comorbid with other behavioral disorders, especially generalized anxiety disorder. Behaviors such as refusal or hesitancy in attending school or homesickness for example, can easily reflect similar symptoms and behavioral patterns that are commonly associated with SAD, but could be an overlap of symptoms. The prevalence of co-occurring disorders in adults with separation anxiety disorder is common and includes a much broader spectrum of diagnostic possibilities. Common co-morbidities can include specific phobias, PTSD, panic disorder, obsessive-compulsive disorder, and personality disorders.
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).