Aim: To assess the predictive value of Middle Ear Risk Index Scores in determining hearing threshold following Tympanoplasty in patients diagnosed with Chronic Suppurative Otitis Media.Materials and methods: This research is an observational cohort design that focuses on 50 patients with chronic suppurative otitis media (CSOM) who were receiving tympanoplasty therapy at the Department of Otolaryngology. Following a thorough medical history and standard examination of the ear, nose, and throat, a pure tone audiometry test was conducted before to the surgery to assess the individual's hearing threshold. The MERI Scores were calculated by adding all the scores and then classified into three categories: mild risk (Score 0-3), moderate risk (Score 4-6), and severe risk (Score >7). Approximately 12 weeks after the surgical procedure, a repeat pure tone audiometry was conducted to assess the hearing threshold after the surgery.Results:The MERI scores categorized the patients as follows: 32% had mild risk (scores between 0 and 3), 48% had moderate risk (scores between 4 and 6), and 20% had severe risk (scores above 7).For hearing thresholds, patients with mild MERI scores had a preoperative mean hearing threshold of approximately 46.13 dB, which improved to about 31.63 dB postoperatively, showing a mean change of 14.50 dB. This improvement was statistically significant with a p-value of less than 0.001. Patients with moderate MERI scores had a preoperative mean hearing threshold of around 51.05 dB, which improved to 38.09 dB postoperatively, resulting in a mean change of 12.96 dB. This improvement was also statistically significant with a p-value of less than 0.001. For those with severe MERI scores, the preoperative mean hearing threshold was approximately 56.78 dB, improving to about 45.67 dB postoperatively, with a mean change of 11.11 dB. This change was significant as well, with a p-value of less than 0.001.Conclusion: Our findings indicate that patients with lower MERI scores, indicating mild risk, showed more significant improvements in hearing thresholds after undergoing tympanoplasty, in comparison to patients with higher MERI scores, indicating moderate and severe risk. The significance of the MERI score in predicting surgical outcomes and informing clinical decision-making for patients with CSOM is emphasized by this.