In ears with advanced pathology the functional and anatomical results of a surgical procedure depend on factors such as total perforation, tympanosclerosis. Atelectasis. Suppuration or possibility a previous operation. A Perichondrium-Cartilage Composite Graft (PCCG) was used to repair the tympanic membrane by a total of 350 cases over a five-year period in total, 157 type I tympanoplasty procedures (15% with previous surgery) and 193 type III procedures (52% with previous surgery) were carried out. The graft was obtained from the tragus and/or the conceal cartilage. Two slightly different surgical techniques were used. Closure of the perforation in the tympanic membrane was successful in 94% of the procedures. An < or = 30 dB in 79% of the type III procedures. In conclusion, the PCCG is a reliable graft in cases of advances middle ear damage