Causes of a ruptured, or perforated, eardrum may include: 1  Middle ear infection (otitis media). 2  A middle ear infection often results in the accumulation of fluids in your middle ear.3  Pressure from these fluids can cause the eardrum to rupture. Foreign objects in your ear. 2  Small objects, such as a cotton swab or hairpin, can puncture or tear the eardrum. 3  Severe head trauma. 4  Severe injury, such as skull fracture, may cause the dislocation or damage to middle and inner ear structures, including your eardrum.