The purpose of the present study is to evaluate the outcome of paper patch myringoplasty for chronic tympanic membrane (TM) perforations and to explore the predictive factors for a successful closure. A retrospective study was performed in a tertiary referral center. Data of the patients who met the inclusion criteria were analyzed: the treatment outcomes and the potential predictive factors including age, sex, the affected ear, hearing level, duration of perforation, causes, location and size of perforations, relationship between the perforation border and the malleus, status of TM surface, and the number of patch applications. Complete closure was achieved in 27 of the total 43 subjects. Among the 11 clinical and TM factors, only the perforation size remained significant as the predictor after multivariable logistic regression (p = 0.029, OR 4.4). The patients with perforation ≤ 5% of the TM showed higher closure rate (78.3%) than those with perforation >5% (45.0%). In conclusion, paper patch myringoplasty showed overall success rate of 62.8%. In patients with perforations smaller than 5% of the TM, the closure rate was 78.3%. The predictor of the treatment outcome was the perforation size. We can try paper patch myringoplasty first in patients who had dry chronic perforations smaller than 5% of the TM without middle ear disease.