Typically clinical
Definition of "complicated or large perforation" (see management):
Significant hearing loss (≥40 dB)
Vertigo
Nystagmus
Ataxia
Facial nerve injury
Large perforation with folded over edges
Prolonged healing
Tympanic membrane rupture
Auricular hematoma
Orbital fracture
Auricular perichondritis
Tongue laceration
Cholesteatoma
Mastoiditis
Contact dermatitis