Objective: Hearing performance after myringoplasty with full-thickness tragal cartilage (FTTC) has been questioned because a considerable difference exists between the graft and natural tympanum. This study aimed to analyze the air-bone gap (ABG) trends before and after myringoplasty and its interaction with risk factors in the FTTC group; further, it compared postoperative ABG in the FTTC group to that in the temporalis fascia (TF) and partial-thickness tragal cartilage (PTTC) groups. Design: A retrospective cohort study Setting: Tertiary care University Hospital Methods: The general linear model repeated measures was used to analyze ABG trends in the FTTC group and its influencing factors. Non-parametric tests were used to compare ABGs in the FTTC group and the other two groups. Propensity score matching was done to balance baseline characteristics between the TF and FTTC group. Results: The mean postoperative ABG in the FTTC group was 12.17±6.58 dB, and 90.9% of the patients had a mean ABG within 20 dB, which improved significantly after surgery (F(1,108)=38.707, P<.001). The tympanic perforation size and malleus handle exposure status, which significantly affected the preoperative ABG, did not affect postoperative hearing (P>.05). In the FTTC group, the mean ABG was comparable to that in the other two groups (P>.05). For all except 250 Hz, a similar audiological performance was observed in the FTTC and PTTC groups; FTTC had a better performance at 250 Hz (Z=-2.277, P=.023). Conclusions: Good hearing performance was achieved after myringoplasty with FTTC, irrespective of the preoperative perforation size and malleus handle exposure status.