Learning Objectives: 2703 tympanic membrane perforations were studied in 1761 children. Data was obtained from a 20 year database containing over 147500 consultations of children seen by the Bristol Paediatric Audiology service. All children who underwent surgical repair of the perforation were excluded from the study. 45% of perforations were related to prior ventilation tube placement. 38% of perforations closed spontaneously within 12 months, 57% by 18 months and 66% by 2 years. 90% of all closures happen within 2.5 years. There is a significant age effect with perforations more likely to close spontaneously in younger children. 90% closure at 2.5 years in children diagnosed <7 years old vs. 75% in children diagnosed aged 7–12 years old. When faced with the clinical question of what period of watchful waiting would be appropriate in monitoring a perforated tympanic membrane, before intervention may reasonably be recommended; there seems to be little advantage in waiting longer than 2.5 years.

2703 tympanic membrane perforations were studied in 1761 children. Data were obtained from a 20 year database containing over 147500 consultations of children seen by the Bristol Paediatric Audiology service. All children who underwent surgical repair were excluded from the study.

45% of perforations were related to previous ventilation tube placement.

38% of perforations closed spontaneously within 12 months, 57% by 18 months and 66% by 2 years. 90% of all closures that will happen occur within 2.5 years.

There is a significant age effect with perforations more likely to close spontaneously in younger children. 90% of perforations closed at 2.5 years in children.

When faced with the clinical question of what period of watchful waiting would be appropriate in monitoring a tympanic membrane perforation before surgical intervention may be reasonably recommended; there seems to be little advantage in waiting longer than 2.5 years.