Hello, I have gone through your query and understand your concern. As you suspected, he may injured his ear drum by q tip or cotton swab. That is why he have hearing loss, ringing in ear and sharp pain in ear. No specific treatment is needed now. these perforation will usually heal by itself within 6-8 weeks. It is a skin-like structure and, like skin that is cut, it will usually heal. But you should consult your Treating ENT Physician, he may give antibiotics or drops to avoid infection. Further he examine the ear and note down where the perforation and is there any foreign body left inside or not. It is best to avoid water getting into the ear whilst it is healing. For example, my advise is to put some cotton wool or similar material into your outer ear whilst showering or washing your hair. It is best not to swim until the eardrum has healed and is confirmed by ENT physician. Hope this helps. Please write back for further queries. Wishing you good health.