Background: The benzodiazepine, Midazolam, has been used medication given for sedation in tympanoplasty and mastoidectomy because of a number of beneficial effects. However, Dexmedetomidine is a highly selective α2-adrenoceptor agonist is emerging as preferred choice now a day. The aim of the study is to compare hemodynamic stability and sedation under Dexmedetomidine vs Midazolam during tympanoplasty and modified radical mastoidectomy done under local anaesthesia. Methods: After obtaining ethics clearance from institution and written informed consent from patients, 50 patients of age group 15 to 50 years of ASA grade i & ii were selected and divided in to two groups: Group D: Inj. Dexmedetomidine 1µg/kg over 15min, followed by 0.5µg/kg/hr (n= 25). Group M: Inj. Midazolam 0.05 mg/kg i.v. slowly, followed by 0.01mg/kg/hr (n= 25). Arterial blood pressure, heart rate and sedation level were monitored. The surgeons and patients were asked to rate their satisfaction, using the Likert scale. Results: Sedation score difference between group Dand group M was not statistically significant. There was no statistically significant difference found in diastolic blood pressure of both the groups. There was a significant reduction in heart rate in group D as compared to group M. Surgeon’s satisfaction score and patient’s satisfaction score both were high in group D compare to group M. Conclusions: For monitored anaesthesia care in ENT surgeries performed under local anaesthesia, inj. Dexmedetomidine could be a better alternative over inj. Midazolam. [Int J Basic Clin Pharmacol 2013; 2(5.000): 562-566