Damage to the tympanic membrane can be caused by what combination of conditions?

• A. Chronic otitis media
• B. Excessive exposure to low-amplitude sounds
• C. Chronic otitis media or excessive exposure to high-amplitude sounds
• D. Headache and fever

Answer: (C)

The tympanic membrane is a delicate boundary that can be injured by inflammatory or mechanical stress. Chronic otitis media means ongoing middle-ear infection, which over time can erode or perforate the tympanic membrane and leave it weakened or torn. Excessive exposure to high-amplitude sounds delivers a strong mechanical force to the membrane, capable of rupturing it in a single event or causing tearing with repeated stress. In contrast, low-amplitude sounds are not typically damaging to the TM, and headaches or fever are not direct causes of tympanic membrane injury (they may accompany ear infections but don’t by themselves perforate the membrane). Therefore, either chronic otitis media or very loud sound exposure can damage the tympanic membrane.