الفهرس 
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Abstract
The goal of tympanoplasty is to reconstruct the tympanic membrane and the sound conducting mechanism. The use of cartilage grafts for repair of tympanic membrane perforations was first introduced by Heermann and has been popular in recent years. Cartilage is considered an ideal graft material; because of its stiffness and lower metabolic needs, in contrast to traditional fascia grafts, it offers a higher mechanical stability particulary in cases of chronic tubal dysfunction, adhesions and subtotal tympanic membrane perforation. The concha or tragus used as a donor site for cartilage.
A variety of methods are used to prepare the cartilage grafts for tympanoplasty, leading to different technical names. The two used techniques in our study are cartilage/composite technique and palisade technique. The cartilage palisade technique are small strips of cartilages laid over as one overlapping the other, this technique is more suitable choice for the management of difficult conditions as it is easier to lay down the cartilage ribbons to accommodate a given defect.
The use of endoscope in tympanoplasty follows the principles of minimal invasive surgery , as it has a significant advantage as it is simple to use & provides a magnified vision than the operating microscope.
Our study done on 46 patient ,with CSOM with cental perforation and underwent endoscopic tympanoplasty using tragal cartilage graft through a transcanal approach. Patients are classified into 2 groups, the first group include 23 patients in whom tympanoplasty is done by cartilage⁄perichondrium composite graft and the second group included 23 patients in whom tympanoplasty was done using cartilage palisade technique.
The study showed that there is improvement in healing and hearing with both techniques ; differences in hearing gain between both techniques was of a statisticaly significance , There is improvement in postoperative ABG in both techniques with a statistically significant difference between the postoperative ABG between both techniques at 500 frequency, with a significant improvement in palisade cartilage technique group , with difference in rate of graft take between both techniques (more taken in cases of palisade technique group was 69.6% while in cases of composite technique group was 62.2%).