Aim of this study was comparison of clinical application of an amniotic membrane in canal wall down tympanomastoidectomy in adults regarding primary outcomes. This was a double blind randomized clinical study in a single center in Dastgheib University Hospital (Shiraz-Iran). Audiologist and statistician as assessors were blind. Patients divided in two groups; amniotic membrane (75 patients) and control group (75 patients). Inclusion criteria were: all patients more than 18 years old, canal wall down mastoidectomy because of choronic otitis media with choleastetoma, final size of tympanic membrane perforation more than 50%. Exclusion criteria were: revision surgery, pre operative medical problems such as asthma, diabetes, coagulation disorders, cardiovascular disease, basic metabolic disorder and chronic liver or renal disease, patients without adequate follow up (less than 6 months), canal wall down mastoidectomy because of other reason such as tumors. Primary outcomes were otorrhea, granulation tissue, epithelialization, tympanic membrane graft successes rate and hearing results at least six months was compared within two groups.