<p>Myringoplasty is the primary surgical treatment for tympanic membrane (TM) perforation, aiming to restore auditory function and TM integrity. Despite advancements, graft failure rates persist. Autologous Platelet-Rich Plasma (PRP), a highly concentrated source of growth factors, is used to accelerate soft tissue healing. This study aimed to determine the efficacy of utilizing autologous PRP as an adjunct to myringoplasty in a larger cohort. The primary objective was to compare graft uptake success at 6 weeks, 3 months,6 months and 1 year, post-operative complications, and hearing gain between patients who received topical PRP application and a control group. A prospective, randomized study was conducted on 252 patients (126 in the PRP Group and 126 in the Control Group) undergoing myringoplasty. PRP was prepared using a double-spin centrifugation protocol and applied topically to the temporalis fascia graft after placement in the case group (Group A). The control group (Group B) received standard care. Patients were followed up for 1 year, and outcomes were assessed via otoscopy (graft uptake) and Pure-Tone Audiometry (PTA) to calculate post-operative Air-Bone (A-B) gap closure. The PRP group demonstrated a superior graft uptake rate at all time points, achieving 96.0% at 1 year (Control: 89.0%). This difference was found to be marginally statistically significant (<i>P</i> = 0.035). Functional hearing outcomes were also superior, with a mean A-B gap closure of 18.5 dB in the PRP group (<i>P</i> = 0.042), suggesting a trend toward clinical benefit. The adjunctive use of autologous PRP in myringoplasty shows a marginally significant benefit, improving graft uptake success and functional hearing recovery compared to conventional techniques. While the clinical improvement is notable, these findings suggest the need for further studies to establish definitive, broadly significant statistical superiority across all population groups.</p>