Objective: The study of correlation between sizes and type of tympanic membrane perforations with degree of hearing loss.Study Design: Cross sectional observational study.Setting: E. N. T OPD, at AGMC & GBP Hospital, Tripura.Materials and Methods: 110 patients (118 ears) of COM (safe type)were selected from Dec 2020 to June 2022. Instruments used for data collection/processing included questionnaires, oto-endoscopy (hand held portable) and microscopy, Pure tone audiometer and image J software.Results: 110 patients (56-males, 54-females), aged 15-60 years (mean age 41.00 years ± 13.99 years) with 118 perforated eardrums were studied. 8(7.3%) had bilateral TM perforations, 53(48.2%) right unilateral and 49(44.5%) left unilateral. The various sizes of perforation and their hearing loss were as follows: Group I (total perforation) no. of ear=3. Group II (subtotal perforation) no. of ear=19. Group III (central perforation) no. of ear = 96. Based on size of perforation GROUP 1 (40mm sq.) 18 examined ears.Amongst the central perforation 19 ears had HL < 35db and 73 ears have mean hearing loss 35 - 55 db and 4ears have HL >55db. Amongst the subtotal perforation11 ears have mean hearing loss 35-55db & 8 ears have HL >55db. Amongst the total perforation 1 ear have HL 35-55db and 2 ears have mean hearing loss > 55db and Difference was significant, P value<0.001.Conclusion: A linear relationship existed between sizes and type of tympanic membrane perforation with degree of hearing loss.