Objective: The aim of this study was to assess the topical application of silver nitrate during myringoplasty for large tympanic membrane (TM) perforation. Patients and Methods: This study was applied on 70 patients who had large dry central TM perforations. The patients were randomly divided into two groups: silver nitrate group for whom silver nitrate 50% was used during myringoplasty and control group that was managed traditionally without silver nitrate. The patients were evaluated on the basis of postoperative graft taking, hearing improvement, and complications. Results: Both groups were statistically matched with regard to age and sex. At 6 months postoperatively, success rate (graft taking) in silver nitrate group was 88.57% and 82.86% in control group with statistically nonsignificant difference (P = 0.49). Success in terms of hearing gain (≥10 dB) was achieved in 23 patients (65.6%) in the silver nitrate group and 12 patients (34.4%) in the control group with statistically nonsignificant difference (P = 0.079). Conclusion: Topical application of 50% silver nitrate during myringoplasty for large TM perforations is safe, provides refreshing the edges of the large TM perforation, and avoids losing any part of the precious remnants of the large TM perforation.