Learning Objectives: The impact of perforation size on tympanic membrane closure in myringoplasty has been well reported in literature. We attempt to summarise the literature findings in a single variable analysis.

Introduction: Graft failure in larger perforations are thought to occur due to increased technical difficult, reduced visibility, reduced graft overlap with the residual tympanic membrane (TM) and a poor vascular bed for graft uptake. However, smaller perforation sizes fail for similar reasons and literature is not conclusive on the significance of perforation size in myringoplasty success.

Aims: The impact of perforation size on tympanic membrane closure in myringoplasty has been well reported in literature. We attempt to summarise the literature findings in a single variable analysis.

Methods: A literature search of all myringoplasty studies from 1966 to 2014 was conducted using PubMed. Retrospective and prospective papers reporting the impact of perforation size and perforation location on graft closure were extracted. A single variable analysis was then performed.

Results: Perforation size greater than 50% surface area of TM had significantly worse graft closure compared to perforation size less than 50%. Data for perforation size >50% came from 58 studies (3374 patients) showing a graft closure rate of 79.44%, compared data for perforation size ≤50% perforation size from 74 studies (5859 patients) showing a closure rate of 85.56% and a p value of 0.019. Perforation location (central, anterior or posterior) was not significant though anterior perforations had the least success.

Conclusions: This single variable analysis indicates that in Type I tympanoplasty, perforations greater than 50% have a lower success rate, while the location of the perforation had no significant effect on success rate.