Background: Chronic otitis media frequently causes tympanic membrane perforation and conductive hearing loss, necessitating surgical repair to restore middle ear integrity and auditory function. Objective: To evaluate graft uptake rates and quantify hearing improvement following Type I tympanoplasty, while analyzing demographic, clinical, and perioperative factors influencing anatomical and functional outcomes. Methods: A prospective observational study was conducted in the Department of ENT, 250 Bedded District Hospital, Chapainawabganj, from January to December 2024. Sixty-eight patients with inactive mucosal chronic otitis media underwent Type I tympanoplasty. Outcomes were assessed using otoscopic examination and pure-tone audiometry. Pre- and postoperative air–bone gaps were compared. Statistical analysis included paired t-tests, chi-square tests, and multivariate regression, with significance set at p < 0.05. Results: Successful graft uptake was achieved in 61 patients (89.7%). Mean preoperative air–bone gap was 32.6 ± 6.8 dB, improving significantly to 15.4 ± 5.2 dB postoperatively (mean gain 17.2 ± 6.1 dB; p < 0.001). Hearing improvement ≥15 dB occurred in 72.1% of cases. Patients aged ≤40 years demonstrated higher graft success (93.5%) compared to >40 years (83.3%; p = 0.041). Posterior perforations showed superior graft uptake (94.1%) versus anterior perforations (81.8%; p = 0.032). Multivariate analysis identified perforation size (β = –0.42, p = 0.018) and middle ear mucosal status (β = 0.47, p = 0.009) as independent predictors of postoperative hearing gain. Conclusion: Type I tympanoplasty provides high graft uptake and significant hearing improvement, with outcomes influenced by patient age, perforation characteristics, and middle ear condition, supporting its effectiveness in chronic otitis media.