Background: The role of topical antibiotic ointment in post-myringoplasty care remains controversial, with limited evidence supporting its routine use. This study evaluated the efficacy of topical antibiotic ointment in lateral graft underlay myringoplasty.Methods: A prospective, randomized, double-blind controlled trial was conducted with 120 patients randomly assigned to receive either topical antibiotic ointment (n=60) or petroleum jelly (n=60) following myringoplasty. Primary outcome was graft uptake rate at 12 weeks. Secondary outcomes included infection rates, healing time, complications, and cost-effectiveness.Results: Complete graft uptake was achieved in 90.0% of the antibiotic group versus 85.0% of controls (p=0.582). Postoperative infection rates were comparable (3.3% vs 5.0%, p=0.648). Complete epithelialization at week 6 was observed in 80.0% and 75.0% of cases, respectively (p=0.509). Complication rates were similar, with granulation tissue being most common (6.7% vs 8.3%, p=0.729). The antibiotic group showed significantly higher costs per successful outcome ($272.8 ± 42.6 vs $256.9 ± 38.4, p=0.038).Conclusion: Routine use of topical antibiotic ointment following lateral graft underlay myringoplasty does not significantly improve surgical outcomes and increases treatment costs. These findings support more judicious use of topical antibiotics in uncomplicated myringoplasty cases.