Objective: The objective of this study was to assess the double layer temporalis fascia grafting for myringoplasty for subtotal tympanic membrane (TM) perforation regarding graft uptake and hearing gain. Methods: The study included 60 patients with subtotal TM perforation attributed to tubotympanic suppurative otitis media. Myringoplasty was done through a postauricular approach using the underlay technique by two layers of the temporalis fascia grafts in the study group and one layer of the temporalis fascia graft in the control group. The procedure was considered successful if there was no residual TM perforation within the follow up period. Results: Within included 60 patients, 30 patients in the study group (11 males and 19 females) and 30 patients in the control group (9 males and 21 females). The success rate of TM healing was 100% in the case group and 87.7% in the control group with significant difference (P = 0.038). The hearing gains (>10 dB) were reported in 96.7% in the case group while it was 70% in the control group which is significantly better (P = 0.00558). Conclusion: The double layer temporalis fascia graft is effective for both postoperative graft taking and hearing improvement for subtotal (Grade 4) TM perforation.