What sign might indicate a perforated tympanic membrane?

A perforated tympanic membrane, often referred to as a ruptured eardrum, can occur due to various reasons, including infection, trauma, or loud sounds. One of the hallmark signs of a perforated tympanic membrane is the presence of purulent drainage from the ear. This drainage is typically a result of an underlying infection in the middle ear, which can lead to the accumulation of pus that drains through the perforation in the eardrum.

While pain in the ear, difficulty hearing, and ringing in the ears (tinnitus) can also occur in cases of a perforated tympanic membrane, they are not definitive signs of perforation. Pain may resolve if the eardrum has ruptured and pressure is released, and the degree of hearing loss can vary. Tinnitus is a symptom that can be associated with many ear conditions but is not an indicator of a perforated tympanic membrane specifically.

Thus, purulent drainage is the most specific sign that suggests the presence of a perforated tympanic membrane, making it the correct answer in this context.