Background: The remaining chronic non healing perforations result in recurrent ear discharge causing great discomfort to the patient and decreased hearing. Objectives: We aimed to assess and compare the results of the underlay and interlay techniques of tympanoplasty type I in cases of medium to large sized dry central tympanic membrane perforation. Patients and methods: Prospective study was carried out on 54 patients having medium to large sized central tympanic membrane perforation who were divided randomly into two groups.Group I patients underwent for underlay tympanoplasty type I, while group II patients underwent for interlay tympanoplasty type I. Hearing results were assessed by comparing the preoperative and postoperative pure tone audiogram as well as closure of the air-bone gap. Results: In terms of graft uptake 3-months postoperatively, in the underlay group, the success rate was 92.6%, while in the interlay group, the success rate was 96.2%. In terms of hearing improvement at the end of the 3rd month, in the underlay group, 40.8% of the patients had hearing gain from 11-20 dB, while in the interlay group, 66.7% of the patients had hearing gain from 11-20 dB. Conclusion: The success rates for the interlay technique are better than the underlay technique and have been quite promising. Therefore, such technique should be more practiced among the surgeons.