BACKGROUND: Chronic suppurative otitis media (CSOM) is commonly treated with tympanoplasty, which has a reported success rate of 85-90%. Success is influenced by various factors, including graft material and surgical technique. The Eustachian tube, vital for middle ear function, can be affected by nasal issues such as deviated nasal septum (DNS), which may impact middle ear ventilation. DNS prevalence is around 22.83%, leading to questions about its effect on tympanoplasty outcomes. MATERIALS AND METHODS: A prospective study was conducted on 50 CSOM patients, divided into two groups based on DNS presence (25 with DNS, 25 without). Patients underwent tympanoplasty using the underlay technique with temporalis fascia graft and were followed for six months to assess graft uptake through otoscopy, microscopy, and audiometry. RESULTS: No significant differences in hearing gain (p=0.3) or graft uptake (p=0.13) were found between the two groups. The A-B gap(air-bone gap) also showed no significant difference (p=0.08). CONCLUSION: The study suggests that DNS may not significantly affect tympanoplasty outcomes, challenging the need for pre-tympanoplasty septoplasty. Larger studies are recommended for further exploration.