Introduction <p>The study aims to evaluate the role of butterfly cartilage tympanoplasty in small to medium sized tympanic membrane (TM) perforations.</p> Materials and Methods <p>Thirty patients with small to medium TM perforations underwent butterfly cartilage tympanoplasty and underwent prospective evaluation. The graft uptake rate and hearing gain were the outcomes evaluated.</p> Results <p>Out of the 30 patients, 17 were male, and 13 were female. The mean age was 36.67 ± 16.02 years (from 15 to 60 years). The overall graft uptake rate was 90%, with failure observed in three cases. The mean preoperative air conduction threshold was 41.17 ± 11.83 dB which improved to 32.27 ± 10.84 dB at 6 months post-operation. The mean postoperative Air Bone Gap (ABG) closure was 7.59 ± 0.28 dB with a p-value of 0.001 which was statistically significant.</p> Conclusions <p>Butterfly cartilage tympanoplasty is the least invasive, safe, simple, and advantageous for healing TM perforation and hearing restoration.</p>