Objective: To evaluate the efficacy of over-underlay graft technique of myringoplasty and compare the results of over-underlay graft technique with conventional underlay myringoplasty. Materials and methods: In this prospective study 40 patients of either sex in age group of 15–50 years with noncholesteatomatous chronic suppurative otitis media (CSOM) were recruited. Patients were initially managed medically to make the ear dry and after that they were operated upon. Twenty patients underwent conventional underlay myringoplasty and 20 patients underwent over-underlay myringoplasty. Follow-up period was at least 3 months. Results: Graft uptake and hearing improvement was comparable in both groups. Although there was 5% lower graft uptake in group underwent conventional underlay myringoplasty (90%) as compared to over-underlay myringoplasty (95%); however, the difference was not statistically significant (P = 0.5). But there was statistically significant difference in gain in hearing threshold (gain in A–B gap) in the conventional underlay myringoplasty (14.5 dB ± 7.236) as compare to over-underlay myringoplasty (18.75 dB ± 5.349 ) (p = 0.04). Conclusion: The over-underlay technique, which is hybrid of both overlay and underlay technique, allows the advantages of both methods. It improves graft uptake rate and hearing improvement in subtotal and large perforations.