Objective: To explore a new method of “four-point fixation” endoscopic myringoplasty with temporal muscle fascia and to explore its clinical efficacy. Method: Patients with large anterior or central perforation of tympanic membrane underwent endoscopic myringoplasty at the Peking University Third Hospital from October 2020 to March 2021 were included in this study and divided into two groups. In observation group, 12 ears were repaired with temporal muscle fascia underwent "four-point fixation" method, and in the control group, 9 ears were repaired with tragus cartilage with perichondrium under endoscopy. Objective evaluation was carried out by endoscopy and pure tone audiometry were conducted 3 months postoperatively. Chinese version of the Zurich Chronic Middle Ear Invertory (ZCMEI) was used to evaluate the quality of life of this two groups from four aspects, including otitis media symptoms, postoperative subjective hearing level, psychosocial impact and medical resources occupation. Results: The graft success rate is 100% in observation group, and the shape of eardrum was closer to normal shallow concave shape. In the control group, there was 1 case left fissure perforation in front, and the success rate of perforation repair was 88.9%. In observation group, PTA and ABG were （22.5±7.5）dB and （10.0±8.2）dB respectively, which were significantly higher than （35.1±12.6）dB and （21.7±8.2）dB respectively (P=0.009, P=0.011). Compared with the control group, the postoperative air conductance of the observation group at 0.25k, 0.5k and 1kHz was significantly improved compared with that before surgery, while the control group was only significantly improved at 0.25kHz. In terms of quality of life score, there was no significant difference between the two groups in otitis media symptoms, postoperative subjective hearing level, psychosocial impact and medical resource occupation (P > 0.05). Conclusion: “Four-points fixation” endoscopic myringoplasty with temporal muscle fascia has the advantage of high graft success rate, natural shape of the postoperative eardrum and good audiometry improvement. This method can be used for tympanic membrane repair in patients with large ear canal, anterior tympanic membrane perforation and high requirements for postoperative hearing improvement.