Myringoplasty is an established procedure. However, the quest is on to improve the results further by studying the different influencing factors, that could possibly affect the outcome. In the present randomized prospective study of one year’s duration, 60 patients having dry, large and subtotal perforations of the tympanic membrane were subjected to myringoplasty, 30 by the overlay technique and 30 by the underlay technique keeping all other influencing factors constant. The graft take-up rate was found to be the same (93.3 per cent) in both techniques but the underlay technique was judged to be better because of its technical ease, better assessment of ossicular chain integrity and mobility, less time consumption (55 minutes vs 90 minutes), earlier healing of graft (four to six weeks vs six to eight weeks), hearing gain in more patients (92.8 per cent vs 57.1 per cent) and fewer minor complications (6.6 per cent vs 33.3 per cent).