Chronic tympanic membrane (TM) perforations are a common problem in otolaryngology. However, there are controversies of how best to treat TM perforation. Recently, we successfully managed TM perforation with paper patch after trimming the perforated TM margin with the CO2 laser. The purpose of this report is to demonstrate the trial of this method and effectiveness. The authors conducted a retrospective case series from March 2000 to January 2005. Ninety patients underwent paper-patch myringoplasty with the CO2 laser. The procedure was performed in an office setting under local anesthesia. We investigated perforation size and postoperative success rate. Successful closure of the TM was achieved in 52.2% of cases (47/90) without any severe complication. The procedure was successful in 16 of 19 (84.2%) cases in perforation smaller than 2 mm, 19 of 29 (63.0%) cases when the size was 2-4 mm, 10 of 25 (40.0%) cases when the size was 4-6 mm, and 2 of 17 (11.8%) cases when the size was > or =6 mm. A significant difference was found: Perforation with <4 mm had the higher closure rate (chi2 test, P < 0.01). There was no correlation between the size of perforation and the number of patch graft (chi2 test, P > 0.05). The results showed paper-patch myringoplasty after CO2 laser trimming is simple and safe to perform, and suitable as an outpatient procedure, especially in small perforations (<4 mm).