Background: Tympanic membrane perforation can result in hearing impairment, recurrent ear discharge, and other otologic symptoms. Tympanic membrane repair aims to restore membrane integrity and improve auditory function. This study evaluated the clinical and audiological outcomes following tympanic membrane repair in adults. Methods: This prospective observational study was conducted at the Department of Otorhinolaryngology, Narsingdi Sadar Hospital, Bangladesh, from January to December 2025. Thirty consecutive adults with tympanic membrane perforation undergoing repair were included. Clinical outcomes, graft uptake, postoperative complications, pure-tone average (PTA), and air-bone gap (ABG) were assessed at final follow-up. Results: Successful graft uptake was achieved in 27 (90.0%) patients, while 25 (83.3%) had complete resolution of ear discharge. Mean PTA improved from 39.1 ± 8.6 dB to 28.0 ± 7.1 dB, while mean ABG decreased from 26.2 ± 6.3 dB to 14.8 ± 5.2 dB (both p<0.001). PTA improvement of ≥10 dB occurred in 76.7% of patients, and 63.3% achieved a postoperative ABG of ≤10 dB. Overall, 66.7% had excellent and 23.3% had good outcomes; no poor outcomes were observed. Conclusion: Tympanic membrane repair provided favorable clinical and audiological outcomes with high graft uptake, significant hearing improvement, and low postoperative morbidity in adults.