Background/Aim: Recently, hyaluronic acid disc has been known to enhance the success rate of fat myringoplasty. However, hyaluronic acid disc (Epidisc) is not covered by south Korean medical insurance. To date, fat myringoplasty using middle ear packing has rarely been reported. In this study, we studied whether middle ear packing with dexamethasone soaked gelfoam and fibrin glue over the fat graft could promote the success rate of tympanic membrane perforation (TMP) closure without hyaluronic acid disc, regardless of perforation size. Patients and Methods: Between January 2005 and July 2020, a total of 209 patients who underwent fat myringoplasty due to chronic TMP at a tertiary referral center were enrolled, and the success rate and audiologic outcomes were analyzed. Results: The mean successful tympanic membrane (TM) closure rate was 88.0%. The success rate by different age groups showed no significant difference. Further, the size of perforation showed no significant difference, and the perforation site (anterior or posterior) was not significant. The preoperative mean thresholds of air conduction (AC),