PurposeBased on a systematic review and meta-analysis, our study aimed to provide information about the factors that influence the success of tympanic membrane reconstruction.MethodsOur systematic search was conducted on November 24, 2021, using the CENTRAL, Embase, and MEDLINE databases. Observational studies with a minimum of 12 months of follow-up on type I tympanoplasty or myringoplasty were included, while non-English articles, patients with cholesteatoma or specific inflammatory diseases, and ossiculoplasty cases were excluded. The protocol was registered on PROSPERO (registration number: CRD42021289240) and PRISMA reporting guideline was used. Risk of bias was evaluated with the QUIPS tool. A random effect model was used in the analyses. Primary outcome was the rate of closed tympanic cavities.ResultsAfter duplicate removal, 9454 articles were found, of which 39 cohort studies were included. Results of four analyses showed significant effects: age (OR: 0.62, CI 0.50; 0.78,pvalue: 0.0002), size of the perforation (OR: 0.52, CI 0.29; 0.94,pvalue: 0.033), opposite ear condition (OR: 0.32, CI 0.12; 0.85,pvalue: 0.028), and the surgeon’s experience (OR: 0.42, CI 0.26; 0.67,pvalue: 0.005), while prior adenoid surgery, smoking, the site of the perforation, and discharge of the ear did not. Four factors: etiology, Eustachian tube function, concomitant allergic rhinitis, and duration of the ear discharge were analyzed qualitatively.ConclusionsThe age of the patient, the size of the perforation, the opposite ear status, and the surgeon’s experience have a significant effect on the success of tympanic membrane reconstruction. Further comprehensive studies are needed to analyze the interactions between the factors.Level of evidenceNot applicable.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00405-023-07831-2.