If there is no significant hearing loss and if there’s no recurrent episodes of ear infection very often . You can avoid surgery and follow water precautions to ear .

If only itching is the reason no need to operate but if there is any your discharge or she is having a reduced hearing which is causing the disability for her then it's better to undergo a surgery diabetes and bp are not contraindications for surgery we can control diabetes and bp and we can undergo surgery so it's all risk and benefit,how difficult it is for you and her to communicate

She is suffering from Chronic Non Suppurative Otitis Media with dry ear. Chronic suppurative otitis media (CSOM) is middle ear inflammation that results in a perforated tympanic membrane with discharge from the ear for more than six weeks. Hearing loss is common among patients with CSOM. The only treatment for chronic otitis media is a surgery called tympanoplasty with or without mastoidectomy. There are no medicines that will cure these diseases. The primary goal of surgery for chronic otitis media and cholesteatoma is to remove all infection. Now if in this case the perforation is a central perforation. If it's left untreated surgically and is under regular check up to avoid any discharge formatation, then it won't harm the patient.

As both the tympanic membrane are damaged she is suffering from hearing loss. There is also risk of middle ear infection with complications,as she is diabetic. You should go for surgery both ears.

No need for surgery if its not recurrent