I would like to discuss the indications and factors which must be considered in advising a tympanoplasty. Every type of lesion of the sound-conducting system which is not due to otosclerosis is, I believe, part of the larger problem of tympanoplasty—of reconstructive middle ear surgery. I have already mentioned that not only dry perforations but also perforations with suppuration, adhesions, or fractures, and even cases of facial nerve trauma and facial nerve neuroma are included in tympanoplasty. For example, I once opened the ear of a patient with middle ear conductive deafness and found some tissue between the facial nerve and the ossicular chain, with absence of the long process of the incus and destruction of the stapes crura. I made a small biopsy of this tissue next to the facial nerve and found that it was a neuroma of the horizontal portion of the facial nerve. A neuroma of