Four decades after the introduction of tympanoplasty, the goal of achi
eving stable and long-term hearing improvement after tympanoplasty sur
gery for chronic otitis media continues to be elusive. In this review,
we focus on the current status of our understanding of the mechanics
and pathology of the middle ear after tympanoplasty surgery. We also a
nalyze some problems and challenges faced by clinicians and basic scie
ntists in the quest for improved postoperative hearing results.