Introduction In the tympanoplastic reconstruction of the ear drum the skin of the external auditory canal and vein or fascia grafts have proven to be the best available tissues. The canal skin and vein may be used either singly or in combination. If the perforation involves less than one-half of the tympanic membrane, either the canal skin or the vein are used singly. In the small perforations, most otologists prefer the vein alone. When the perforation involves more than one-half of the tympanic membrane, I prefer to use the sliding canal graft combined with vein or fascia. The sliding canal graft may be the superior or inferior skin of the external auditory canal. The superior sliding canal graft is essentially a fenestration-type flap with the elevation in continuity of the squamous epithelium from the outer portion of the drum membrane. The endomeatal graft utilizing the skin of the superior anterior