When should a tympanic membrane perforation be repaired? This is a complicated question, depending on the cause, location, size, hearing condition, accompanying symptoms and general condition of the perforation. 1. If the perforation is caused by trauma and is small, you can observe it first, keep the outer ear canal dry and hygienic, and prevent colds. In general, it can heal on its own in about one month. If the perforation is large, the edge of the perforated tympanic membrane may curl inward and the tympanic membrane epithelium may lose its scaffolding, which may affect the healing of the tympanic membrane or even prevent it from healing, but in still need to observe for 2-3 months or even longer to give the tympanic membrane a chance to heal on its own. In the case of tympanic membrane perforation due to cranial trauma, strict observation for cerebrospinal fluid leakage is required, and sometimes brain surgery is required for collaborative diagnosis and treatment. 2. If the tympanic membrane is centrally perforated due to chronic otitis media and the hearing is basically normal and there is no pus flow for a long period of time, it can be temporarily observed because surgical repair cannot guarantee that the hearing will remain normal after the operation. Normally, it is important to prevent water from entering the external ear canal and to prevent colds. If the pus flows for a long time or frequently and the hearing is poor, surgical treatment can be performed in between the flow of pus. 3. Marginal perforation of the posterior tympanic membrane should be repaired as early as possible because the epithelium of the external auditory canal may crawl into the tympanic chamber through the perforation and accumulate, risking the formation of cholesteatoma. 4. The perforation above the tympanic membrane (or the opening with pouch inward, which looks like a perforation) is usually a manifestation of cholesteatoma formation, and the timing of surgery will be decided according to what is seen by hearing and CT (if necessary, MRI is needed to understand whether there are intracranial and extracranial complications), which usually requires early surgery to avoid complications. 5.The possibility of surgery also depends on the patient’s general condition (is there any underlying disease? How is the control?) Unless it is an emergency surgery, tympanic membrane repair should generally be considered when the patient is in good health. In addition, the tympanic membrane repair should be performed when the external ear canal is dry and free of infection as much as possible, so that the repair can be successful.