Background: Berberine hydrochloride demonstrates a wide range of pharmacological actions, such as anti-inflammatory, antibacterial, antifungal, and antioxidant activities., During a tympanoplasty procedure, It has the potential to be applied to grafting materials as a sealer and adjuvant. This study's purpose was to assess the effectiveness of berberine hydrochloride as an adjuvant in type 1 tympanoplasty (myringoplasty) to repair safe type of tympanic membrane perforations . A prospective comparative study including 56 patients having dry central TM perforations was conducted. Two equal groups of patients were created: group A (case group) underwent myringoplasty surgery for berberine hydrochloride addition to the perichondrial graft and group B (control group) underwent type 1 tympanoplasty with only the graft . For successful perforation closure, both groups were evaluated. An intact eardrum with closure of the air-bone gap to 10 dB or less, and hearing gain 6 months after surgery is the definition of success. Six months after surgery, group A (96%) had a significantly higher success rate (graft taking) than group B (78%). With relation to air-bone gap closure ( <10 dB), success was achieved in 25 patients (89%) of group A, which was significantly more than the 21 patients in group B (75%). At 6 months after surgery, the air-bone gap was significantly larger in the graft-taken cases in group A (case group)than in group B (control group ) .In both groups,we found a nonsignificant relationship the perforation size and graft uptake. Conclusion: Berberine hydrochloride which is an isoquinoline derivative alkaloid isolated from a variety of plant species could be used as adjuvant to increase myringoplasty overall success rate. while having no discernible side effects. Keywords: type 1 tympanoplasty , Berberine hydrochloride, healing , myringoplast