Most tympanic membrane perforations are caused by otitis media and trauma. Large perforations can easily cause reperforation because there are few, if any, residual edges of the tympanic membrane and lack of sufficient edges to hold down the material used for repair when performing tympanic membrane repair. In addition, chronic otitis media and large perforations result in poor blood flow to the graft bed, making it difficult for the graft material to survive and leading to repair failure. The more common material used to perform tympanic membrane repair is autologous temporalis fascia. It has the advantage of being relatively thin, relatively easy to manipulate, and the postoperative vibratory properties of the tympanic membrane are close to those of the natural tympanic membrane. Another suitable material for grafting is the cartilage-chondral composite of the ear screen, which has the advantage of being stronger, but is thicker than the normal tympanic membrane and more difficult to manipulate. There is no absolute advantage or disadvantage between these two methods, and both are commonly used. The surgeon will choose according to each patient’s condition. As long as physical conditions permit, I recommend that tympanic membrane perforations due to various causes should be repaired, not only to improve hearing, but also, and more importantly, to prevent recurrent episodes of suppurative otitis media leading to further hearing loss, neurological deafness, tinnitus, and secondary cholesteatoma. For a description of cholesteatoma, see my other articles. It is important to avoid activities such as air travel and diving with significant changes in air pressure after tympanic membrane repair to avoid excessive changes in middle ear pressure leading to failure of tympanic membrane healing or reperforation.