This chapter discusses tympanoplasty which is defined as the eradication of the disease from the middle ear along with reconstruction of hearing mechanism. Myringoplasty is the simple repair of the perforation of tympanic membrane. The term tympanomastoidectomy is used when tympanoplasty is performed along with mastoidectomy. In underlay technique of myringoplasty, graft is kept medial to fibrous layer, whereas in overlay technique graft is kept lateral to fibrous layer of tympanic membrane. Tympanoplasty type III is also called myringostapediopexy or columella operation. This columella effect is normally present in birds. Cardinal principles of tympanoplasty are control of infection and reconstruction of sound conducting mechanism. Patch test is performed to know whether ossicular chain is intact or not. Blunting of anterior sulcus if severe causes fixation of handle of malleus leading to conductive hearing loss. Maximum conductive hearing loss is seen in ossicular chain disruption because both windows lie behind sound protection and there is no pressure transformation for oval window.