Background:Any level of hearing loss may be very crippling as it can impede social and professional communication. Reversible hearing loss is the most common cause of persistent tympanic membrane (TM) rupture resulting from chronic otitis media.Objectives:To evaluate how a TM perforation's size and location affect hearing level.Materials and Methods:This study included 100 patients who were between the ages of 18 and 60 and had central TM perforations participated in the research study. Participants who were diagnosed with active chronic suppurative otitis media, cholesteatoma, or granulation tissue, or were suffering from atticoantral disease, ear with sensorineural hearing loss, were not included in the study. Patients clinically presenting with ear symptoms were selected. Patients subjected to otoendoscopy and pure tone audiometry. Only patients with pars tensa perforation were selected.Results:Among 100 participants (median age: 35.5 years and 39% female), 96% had hearing loss, and only 3% reported ear pain. Right ear involvement was more common (56%). Small TM perforations were most frequent (51%), mainly in anterior quadrants (74%). Posterior perforations had higher rates of moderate to severe hearing loss (57.7%).Conclusion:Our study highlights a significant correlation between the size and location of tympanic membrane (TM) perforations and the severity of hearing loss. Posterior perforations were associated with greater hearing impairment compared to anterior perforations, emphasizing the role of anatomical placement in sound conduction. These findings reinforce the need for early diagnosis and targeted interventions to prevent progressive hearing deterioration. Future research with larger sample sizes and longitudinal follow-ups can further validate these observations and contribute to improved clinical management of TM perforations