Hello user.. . When the perforation is large then it doesn't heal on its own and cause hearing problem for that ear. With continuous perforation the water and infection enters the ear which is very bad for the ear Yes the operation is done with an endoscope without any cut or sutures but for that one needs to look at the ear if there is a space or not... If there is space if can be done easily.... If the space is very less then a small incision is given with a si gle suture.... We have the technology now.... Don't worry....