الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Reconstruction of Subtotal TM perforation is always challenging to otologists due to high risk of graft uptake failure. Using of single layer graft: composite (tragal cartilage & perichondrium ) graft always used for this purpose but in our study we modify a surgical technique using double layer graft : Temporalis fascia + tragal cartilage & perichondrium to get better results regarding Hearing improvement & more successful graft uptake .
We concluded from our study that Tympanoplasty by double graft achieving a considerable improvement in healing of TM with lower risk for residual perforation or graft rejection and also is better than single layer as regard postoperative improvement of hearing.
Therefore, Double layer graft technique is recommended in cases with higher possibility of residual perforation such subtotal perforation especially through postauricular approach with using of microscope.