Perforation of the eardrum may have multiple different causes. It can be caused by infection, trauma, or less commonly as a sequella of actual ear tube insertion. There are two main reasons to close an eardrum perforation. The first is that water exposure through the perforation places and inoculates bacteria into the middle ear. A recurrent infection of the middle ear space will usually result. The other reason for closing and patching a perforation is that skin from the outer side of the eardrum “dry skin” can abnormally grow through the perforation into the middle ear space behind the eardrum “wet skin”. The result is that the dry skin builds-up in the area behind the eardrum and will give rise to recurrent infection. This is known as “cholesteatoma”. To prevent recurrent ear infections from water exposure and skin growth (cholesteatoma), the perforation is best closed. The closure is usually performed with a microscope through the ear canal as an outpatient.