We have assessed children with perforations of the pars-tensa presenting to an otolaryngology clinic over a 7-year period. We found that over 70% of the perforations followed the insertion of a ventilation tube. Using a novel method of dividing the tympanic membrane into quadrants, we were able to assess the sites and grade the size of perforations. The most common site of involvement, in all perforations, was the antero-inferior quadrant. With the exception of perforations following the use of T-tubes, we found little difference between the sites, sizes and hearing levels of ventilation tube and non-ventilation tube related perforations. Larger perforations resulted in a greater degree of hearing loss.