In acute otitis media, which finding would indicate a tympanic membrane perforation?

• A. Rapid relief of pain and otorrhea
• B. Persistent severe ear pain
• C. Facial droop
• D. Ear pain with no relief

Answer: (A)

When the tympanic membrane ruptures in acute otitis media, the built-up pressure in the middle ear is suddenly released. That relief of pressure often causes the pain to drop quickly, and purulent drainage appears in the ear canal. So rapid pain relief accompanied by otorrhea is the telltale sign of a perforated tympanic membrane.

Persistent severe ear pain suggests the membrane is still intact and inflammation continues. A facial droop could indicate a more serious complication involving the facial nerve. Ear pain with no relief is typical of pre-perforation stages before rupture.