What physical examination finding might suggest a perforated tympanic membrane?

The identification of a hole in the tympanic membrane is a definitive physical examination finding that indicates a perforated tympanic membrane. When a tympanic membrane is perforated, it means there is a rupture or tear in the membrane, which can occur due to infection, trauma, or sudden pressure changes. During an examination, a physician looks for this clear structural abnormality, which is directly observable through otoscopy.

While the presence of yellow discharge or fluid behind the tympanic membrane may suggest an ear infection or other pathology, they are not definitive signs of perforation. Similarly, redness of the outer ear might indicate inflammation or infection but does not directly relate to the integrity of the tympanic membrane itself. Therefore, visualization of the actual hole is the most accurate indicator of a perforated tympanic membrane.