Background: Underlay technique is the most common and time tested technique, is typically used for posterior perforations, whereas the overlay technique is more technically challenging and particularly suited for anterior large or subtotal perforations. The present study compared over underlay graft technique with conventional underlay myringoplasty in patients with mucosal CSOM. Materials & Methods: 90 patients of chronic suppurative otitis media of both genderswere divided into 2 groups of 45 each. Group I patients were treated with conventional underlay myringoplasty and group II patients with over underlay myringoplasty. Parameters such as status of graft, size of perforation, degree of hearing loss etc. was compared in both groups. Results: Group I had 25 males and 20 females and group II had 23 males and 22 females. Degree of hearing loss was mild seen in 36 in group I and 32 in group II, moderate 9 in group I and 13 in group II. Site of perforation was grade IV seen in 13 in group I and 15 in group II and grade V 32 in group I and 30 in group II. Graft status was graft taken up in 40 in group and 41 in group II and graft failure was 5 in group I and 4 in group II. The difference was significant (P< 0.05). Air born gap value pre-op was 35.2 dB in group I and 39.6 dB in group II and post- op was 19.4 dB in group I and 19.2 dB in group II. The difference was significant (P< 0.05). Conclusion: The over underlay technique found to be better than conventional underlay myringoplasty. The over underlay technique has advantages of graft uptake rate.