Abstract Objectives The aim of this study was to evaluate whether adding an extra perichondrium patch to enhance the cartilage graft during endoscopic myringoplasty can improve the healing rate and post-operative hearing of patients with poor prognostic factors (eustachian tube dysfunction, large perforations, subtotal perforations and marginal perforations). Methods This retrospective study analyzed a total of 80 patients (40 females and 40 males, median age of 40.55 years) who had received an extra patch during endoscopic cartilage myringoplasty. Patients were followed up for six months. Healing rates, complications, preoperative and postoperative pure-tone average (PTA) and air-bone gap (ABG) were analyzed. Results At six months follow-up, the healing rate of tympanic membrane was 100% (80/80). The mean preoperative pure-tone average (PTA)（43.18± 14.57 dB HL）significantly decreased (27.08±9.36 dB HL) six months after the operation (P=0.002). Similarly, the mean preoperative ABG（19.05±5.72 dB HL）reduced to（9.36±3.75 dB HL） (P=0.0019) at sixth month. Major complications were not observed during follow-up. Conclusions The usage of an extra patch during endoscopic cartilage myringoplasty for large, subtotal and marginal tympanic membrane perforations achieved a high healing rate and a statistically significant hearing gain with low incidence of complications.