Abstract: BACKGROUND: Blast injury of the ear due to explosive force can result in perforation of the tympanic membrane and damage to the middle ear structures. This study evaluated the middle ear and audiological outcomes in 70 men with persistent traumatic tympanic membrane perforation fighting the war in Ukraine. MATERIAL AND METHODS: Participants underwent basic audiological assessment (otoscopy and pure-tone audiometry) and surgery between 2023 and 2024. RESULTS: Perforation of 2 quadrants compared to 1 quadrant was associated with greater hearing loss (p=0.004) and larger air-bone gap (p<0.001). Lesioning of 2 quadrants was also associated with more middle ear lesions (p=0.033). Surgery improved hearing compared to preoperative data (p<0.001). Postoperatively, we noted the shift in air conduction threshold level compared to bone conduction threshold level (ie, closure of the air-bone gap) (p<0.001). CONCLUSIONS: Tympanic membrane perforations primarily occur in 2 quadrants, leading to more significant hearing loss and a larger air-bone gap (ABG), with a statistically significant difference. No significant difference in ABG was found between the anterior and posterior quadrants. The risk of epidermal complications in the eardrum cavity is quite high, even with small to medium-sized perforations. Surgical intervention was found to improve middle ear conditions and enhance hearing outcomes.