Background: This study is a prospective cross-sectional study, Six months, starting from July 2020 till December 2020. The sample size was estimated to be 24 cases. As the expected number of patients attending at otorhinolaryngology surgery department and fulfilling the inclusion criteria is about 4 patients /month (24 / 6 months), and all of them were included in the as a comprehensive sample. Results: The mean age of cases was 36.42 years (range, 16 – 63 years). Females constituted 58.3% of the study group, whereas the remaining portion was occupied by males. The duration of perforations had a mean value of 2.76 months. Most cases had only one perforation, but overall, their number ranged between 1 and 4. Trauma was the commonest cause in the current study (58.3%), followed by chronic suppurative otitis media (41.7%). The right sided perforations were more prevalent as it was affected in 66.7% of cases.History of ear discharge was positive in 10 cases (41.7%). It was positive in cases with positive history of otitis media. The number of topical insulin installations ranged between 4 and 14 (mean = 8.29). Over the scheduled follow up visits, the perforation size showed a significant decrease from 1.48 mm at baseline down to 0.89, 0.67, and 0.54 at 1-week, 1-, and 2-month visits (p < 0.001). Conclusions: Based on our findings, topical insulin therapy appears to be a hopeful and safe option for small central tympanic perforations, with more favorable outcomes in traumatic versus infective cases. Key words: Air bone gap, Acute otitis media, Cerebrospinal fluid, Epidermal growth factor receptor, Round window, Tympanic membrane perforation Vascular and epidermal growth factor