A hole in the ear drum can be due to infection in ear or trauma to eardrum
or due to related problems of middle ear , eustachian tube or skull bone mastoid.
The decision for surgery wil depend on cause and extent of damage and the resultant hearing loss
.If its a very small central hole recently caused by acute infection and not resulting in significant hearing loss then it may heal with antibiotics, but in most other cases surgery may be required.
Hope I have answered your query.thanks