OBJECTIVE: The objective of this study was to evaluate graft success, hearing improvement, and complications following perichondrium-cartilage underlay myringoplasty without external auditory canal packing. METHODS: In this prospective study, we examined 37 ears of 37 patients with large perforations who underwent endoscopic perichondrium-cartilage underlay myringoplasty without external auditory canal packing. Patients were followed up for six months. RESULTS: At one week after the surgery, the graft was in situ in 35 (94.6 per cent) ears. At 2-3 weeks post-surgery, among the 35 ears without infection, the graft was in situ in 29 (82.9 per cent) ears, and the graft was bulging in 6 (17.1 per cent) ears. At six months post-surgery, the graft success rate was 94.6 per cent (35 of 37 ears). No graft lateralisation or graft medialisation was encountered during the follow-up period. CONCLUSION: The absence of external auditory canal packing did not affect the graft success or hearing improvement following underlay myringoplasty. Thus, external auditory canal packing does not appear to be necessary for underlay myringoplasty.