Background: Mastoid pneumatization is an anatomical feature that can impact surgical outcomes in tympanoplasty Type 1 operations. The relationship between mastoid pneumatization and the success of tympanoplasty procedures is a topic of growing interest within the field of otolaryngology.
Aim: This study aimed to detect the role of mastoid pneumatization in predicting tympanoplasty type 1 operation success.
Subjects and Methods: Between February 2023 and February 2024, 40 patients attended in the otorhinolaryngology head and neck surgery department at Al-Azhar University Hospital [Damietta] participated in this prospective trial. Cases diagnosed with COM, medium-sized central tympanic membrane perforations, underwent CT scan for mastoid information, including pneumatization, and underwent endoscopic type I tympanoplasty with tragal cartilage graft.   
Results: All patients diagnosed as mild conductive hearing loss with air-bone gap 20.0±5.58 dB underwent endoscopic tympanoplasty with tragal cartilage graft, resulting in a 90% success rate for graft taking and 10% failure graft taking.  Utilizing a CT scan, we were able to determine that out of the 36 successful cases of tympanoplasty that we studied, 4 cases had failed following tympanoplasty. The success group showed a significant increase in longitudinal, transverse, surface area and total volume dimensions while the failure group did not.
Conclusion: Significant increases were observed in longitudinal, transverse, total volume, and surface area for the success group compared to the failure group.