Background: Longstanding Tympanic Membrane (TM) perforations may cause hearing loss and middle ear infection even if they are small in size. Further, the patients have to observe water restrictions. The purpose of myringoplasty is to repair such perforations and thus to improve hearing and eliminate the susceptibility to middle ear infectionsObjectives: This study was carried out in ENT Department of Zagazig University Hospitals to compare the effectiveness of fat myringoplasty and perichondrium tympanoplasty in treatment of chronic tympanic membrane perforations in small and large sized perforations.Patients and methods: This study comprised 40 patients who were divided into 4 groups: Group IA included 10 patients who have undergone fat myringoplasty with tympanic membrane perforation diameter < 4 ml. Group IB included 10 patients who have undergone fat myringoplasty with TM perforation diameter > 4 ml. Group IIA included 10 patients who have undergone perichondrium tympanoplasty with tympanic membrane perforation diameter < 4 ml. Group IIB included 10 patients who have undergone perichondrium tympanoplasty with perforation diameter > 4 ml. In our study, 17 patients were males and 23 patients were females. All patients were well prepared and investigated for selection of patients who can be operated. All patients were operated and discharged from the hospital in the same day of operation and followed up in outpatient clinic of Zagazig University Hospitals, ENT department.Results: As regard the healing, in fat myringoplasty, the success rate was 80% in group IA and 20% in group IB, while in perichondrium tympanoplasty, the success rate was 80% in group IIA and also 80% in group IIB.Conclusion: There was improvement of hearing in all successful cases with no significant differences between fat group and perichondrium group.