Tuberculosis of the Middle Ear!
The image of the ear drum shows multiple perforations. This is characteristically seen in tuberculosis of the middle ear or tuberculous otitis media. Multiple perforations later coalesce and form a single large perforation which discharges caseous material. The discharge is typically painless. It is often accompanied by marked hearing loss. Most cases occur secondary to pulmonary tuberculosis, the bacteria seeding into the middle ear through the Eustachian tube during expectoration of sputum. It may also spread hematogenously. Treatment involves systemic antituberculous drugs (Isoniazid, Rifampicin, Pyrizinamide and Ethambutol) along with local aural toilet or mastoid surgery as required. Image via: http://www.kmis.medicine.cu.edu.eg/mis/EAR/Chronic%20perforations.htm
Is the hearing loss permanent? Does the ear drum repair itself
It depends on the extension of the disease. If the inner ear is also involved, sensorineural loss may be permanent but conductive loss involving the middle ear and ossicular chain can be corrected with antituberculous therapy and tympanoplasty. Similarly, the eardrum perforation may or may not repair.