A tympanic membrane perforation can be surgically repaired through a procedure called tympanoplasty or tympanic membrane repair. This procedure involves repairing the perforation through a tissue grafting technique to restore the integrity of the tympanic membrane in order to improve hearing. This procedure has been performed for more than 100 years. In the last 40 years, thanks to the advent of the surgical microscope, microsurgery and grafting techniques, and the introduction of new antibiotics, the success rate of tympanic membrane repair surgery has reached 90%, making it a classic procedure and laying an important foundation for tympanoplasty. If the inflammation of the middle ear remains untreated or has granulation growth, or if there is a marginal perforation in the loose or tense part of the tympanic membrane, a CT scan should be performed to clarify the nature and extent of the lesion, surgical removal of the lesion and selective tympanoplasty according to the condition. Most tympanic membrane perforations are caused by purulent otitis media and trauma, and most can heal spontaneously with appropriate treatment. A tympanic membrane repair test should be done before surgery to find out if the auditory chain is interrupted. If there is an improvement in hearing, it means that the auditory chain is intact and movable and suitable for tympanoplasty. If the auditory chain is fixed or interrupted, only other types of tympanoplasty can be performed according to the condition. The operation can be performed under local anesthesia, or general anesthesia can be used for uncooperative children or for highly nervous and fearful children. A small incision is made in the ear canal and the tympanic membrane perforation is repaired using a variety of methods. Materials used to repair tympanic membrane perforations include the patient’s own temporalis fascia, the cartilage membrane of the ear, etc., but also allogeneic dura mater, vein sheets, periosteum, or synthetic biomaterials. Currently, the most commonly used and most effective material is the patient’s own temporalis fascia. The transplanted temporalis fascia is trimmed to the appropriate shape and size and overlapped with the edges of the perforated tympanic membrane, which can also be reinforced with biological glue. After the surgery, antibiotics are applied to prevent infection and the new tympanic membrane is tightly bonded to the perforated tympanic membrane after 10 to 14 days, which gradually thins to a translucent “tympanic membrane”. Thanks to endoscopic surgery, simple tympanic membrane repair has become much simpler, and small to medium-sized perforations can be repaired by taking a small piece of fat from the earlobe, with a very concealed scar. The following is a series of photos of an endoscopic repair of a tympanic membrane perforation. Before and after the operation, the sponge was filled with gelatin two weeks later and the fat graft was alive and red in color, which will gradually transform into a normal tympanic membrane.