OBJECTIVE: To investigate the morphological changes of the new tympanic membrane at different stages after tympanoplasty, as well as the relevant factors and countermeasures influencing the changes. METHODS: In 120 tympanoplasty cases, we observed the changes of the new tympanic membrane at 1-3 months, 4-6 months, 6-24 months and more than 2 years after surgery, analyzed the relevant factors affecting the changes, and carried out relevant treatments. RESULTS: Four ears were seen to have fissures on the anterior and inferior edges of the new tympanic membrane after withdrawal of the external auditory canal gauze 2 weeks after surgery, 2 ears were seen to have re-infected perforations at 1-3 months, 24 ears were seen to have suspected eustachian tube malfunction at 4-6 months, 4 ears had not recovered function, and 13 ears had tympanic membrane atrophy at 4 months and 2 years. Total postoperative secondary perforation was 10 ears (8.33%). Conclusion: The anterior and inferior marginal fissure of the new tympanic membrane was the main manifestation of early tympanic membrane perforation; severe mucosal lesions of the tympanic chamber and the eustachian tube bullae were the main cause of new tympanic membrane perforation and affected graft survival. Eustachian tube blowing is one of the methods to improve the ventilation of the tympanic chamber and improve hearing. The function and morphology of the new tympanic membrane tend to stabilize after 3 months.