<p>This study aimed to compare the efficacy of platelet-rich fibrin (PRF) with collagen patching versus the conventional paper patch technique for healing tympanic membrane perforations and improving hearing outcomes. A total of 40 patients were enrolled, evenly distributed between two groups: PRF with collagen patch (Group A) and paper patch (Group B). The age range of participants was 18–60 years, with a mean age of 34.65 ± 11.20 years in Group A and 43.20 ± 10.36 years in Group B. At 30 and 60 days, Group A demonstrated higher rates of tympanic membrane closure (30% and 60%, respectively) compared to Group B (15% and 45%, respectively), though differences were not statistically significant. Success rates in traumatic perforations were 100% for both groups, while in cases of mucosal chronic otitis media, Group A exhibited a higher success rate (55.55%) compared to Group B (42.11%). Quadrant-specific analysis revealed superior outcomes in the anterior-inferior and anterior-superior quadrants with PRF and collagen patching. Improvement in air-bone gap (ABG) was more pronounced in Group A, with 35% of patients achieving an ABG closure of less than 10 dB at 60 days, compared to 15% in Group B. This study highlights the potential advantages of PRF with collagen in enhancing tympanic membrane healing and hearing recovery. While differences in outcomes were not statistically significant, the observed trends underscore the need for further large-scale studies to validate the clinical efficacy of PRF with collagen patching as a superior alternative to conventional paper patching.</p>