Transcanal-Transtympanic myringoplasty was done in (72) cases, where only perichondrium was used. The onlay grafting was done in (100) cases, and underlay grafting was done in (128) cases. In this group the graft take rate was (96%) and failure rate was (4%) due to infection, displacement of graft. The hearing gain with SRT was achieved within 15 dB of BC. The failed cases had to undergo revision myringoplasty. The follow up was achieved in 75% of the cases for over 3 years. 2. Ossiculoplasty Group: Total (110) cases: These cases were done by underlay and over lay technique for reconstructing the tympanic membrane and ossicular chain with various combinations of different cartilage-perichondrium assembly struts. 3. Ossiousplasty group: Total (70) cases: (Reconstruction of bony defects of attic, PSQ and bony annulus). Here all the bony defects were reconstructed with cartilage-perichondrium plates. The defects were due to cholesteatoma, or surgical trauma was first removed by radical surgery clearing all the disease entity from attic aditus. 4. Mastoid Obliteration Group: Total cases (120): All mastoid cavities were vigorously treated with oto-microscopic suction clearance for 4 to 6 weeks. Along with systemic antibiotics and local steroidal and antifungal ear drops until the cavities were dry enough to undergo obliteration procedures. The cavities were drilled with cutting and diamond burrs and all residual disease were cleared. I personally like to use cartilage perichondrium palisade plasty for obliteration of the cavities.