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Background: The tympanic membrane (TM) forms the partition between the external auditory canal and the middle ear. Perforations occur as a result of acute otitis media or traumatic causes which undergoes healing spontaneously over 3 to 4 weeks. Non-surgical methods are successful in the closure of small to medium-sized perforations. Chemicals used for the cauterization of the margins of perforation are trichloroacetic acid and silver nitrate. This study was performed in a total of 90 patients. External auditory canal, tympanic membrane, site and size of perforation, and middle ear mucosa status were assessed followed by pure tone audiometry. One group constituting 45 subjects underwent TCA cauterization under sterile precautions. Another group of 45 subjects underwent the same procedure with TCA cautery and gel foam application for perforation closure. The procedure was repeated once a week for about 6 weeks. The effectiveness of these two procedures was compared between the two groups after a waiting period of 2 weeks. Results: The mean age of the study population is 41.84 ± 16.71. Of the 90 study participants, 54.4% (N= 49) were less than 40 years of age, gender, cause, and laterality of perforation were not associated with the outcome whereas the size of the perforation was significantly associated with the closure of TM perforation with chi-square value of 7.028 and Pvalue of 0.008 (< 0.05). Overall, TM closure was achieved in 3.56 applications in TCA with gel foam patching whereas in 6.02 applications with TCA alone. Conclusion: TCA cauterization with or without gel foam patching can be performed as a first-line treatment in adults with small to medium-sized perforations.