Aim:This study aimed to compare the efficacy and safety of intravenous dexmedetomidine versus midazolam during tympanoplasty performed under monitored anesthesia care (MAC), focusing on sedation quality, hemodynamic stability, patient comfort, surgeon satisfaction, and adverse effects.Material and Methods:This prospective, randomized, comparative study included 100 adult patients undergoing tympanoplasty under MAC. Patients were randomized into two groups: Group D (n=50) received intravenous dexmedetomidine, and Group M (n=50) received intravenous midazolam. Sedation was assessed using the Ramsay Sedation Scale, while hemodynamic parameters (heart rate, mean arterial pressure, systolic and diastolic blood pressure, and SpO2) were monitored at regular intervals. Patient comfort and surgeon satisfaction were evaluated using a visual analog scale and a 5-point Likert scale, respectively. Adverse effects, including bradycardia, hypotension, and respiratory depression, were recorded. Statistical analysis was performed using SPSS version 16.0, with significance set at p<0.05.Results:Group D showed significantly better sedation scores at all intervals (p<0.001). Hemodynamic parameters, including heart rate, mean arterial pressure, and systolic and diastolic blood pressure, were more stable in Group D, with significant reductions observed throughout the procedure (p<0.001). Patient comfort scores were higher in Group D (9.1 ± 0.6 vs. 8.3 ± 0.8, p<0.001), as was surgeon satisfaction (4.7 ± 0.5 vs. 4.2 ± 0.6, p=0.002). Adverse effects were mild and manageable in both groups, with a slightly higher incidence of bradycardia (12% vs. 4%) and hypotension (8% vs. 2%) in Group D.Conclusion:Dexmedetomidine provided superior sedation, enhanced patient comfort, and better surgeon satisfaction compared to midazolam during tympanoplasty under MAC. It also ensured better hemodynamic stability and minimal respiratory compromise, although bradycardia and hypotension were more frequent but manageable. Overall, dexmedetomidine is a more effective and reliable sedative for tympanoplasty.