Purpose <p>To investigate the impact of risk factors on the timing of reperforation (RP) after tympanoplasty and to determine the optimal follow-up intervals.</p> Methods <p>This retrospective study included 403 patients who underwent tympanoplasty with at least 2&#xa0;years of follow-up. The patients were divided into RP (<i>n</i> = 32) and non-RP (<i>n</i> = 371) groups. Data on age, sex, BMI, diagnosis of diabetes mellitus, smoking, atopy, perforation size and type, and middle ear status were collected based on factors previously reported to affect the graft outcomes. Group comparisons were made to identify factors associated with RP. Time-to-event analysis (Kaplan–Meier) was used to assess the effect of variables on RP timing, and linear regression was conducted to determine predictors of shorter RP time.</p> Results <p>Of 403 patients, 32 experienced RP. Larger (&gt; 50%), marginal perforations, diabetes mellitus, and smoking were significantly associated with RP. Marginal perforations (11.56 ± 5.73&#xa0;months), diabetes mellitus (10.72 ± 5.09&#xa0;months), and smoking (11.83 ± 4.79&#xa0;months) individually led to significantly shorter RP times. The coexistence of smoking, diabetes mellitus, and marginal perforation resulted in the shortest mean RP time (6.58 ± 4.14&#xa0;months). Linear regression confirmed diabetes mellitus as a significant predictor of a shorter RP time (B = -3.161, <i>p</i> = 0.049).</p> Conclusion <p>Our findings show that marginal perforations, diabetes mellitus, and smoking not only increase the risk of RP, but also significantly accelerate its timing, especially when combined. This requires closer and tailored postoperative monitoring for high-risk patients to improve the long-term success of tympanoplasty.</p> <p><b>Level of evidence:</b> 4</p>