AbstractMyringoplasty is considered the simplest reconstructive procedure of the middle ear. There are many variations and types of myringoplasties. In the past, these variations were categorized according to the types of tissue and the way the tissue was fixated in the middle ear. Currently, the types of myringoplasties are differentiated only by the fixation of the transplant, because a majority of ear surgeons use only fascia, perichondrium, or cartilage. The percentage of successful healings after myringoplasties does not depend on the tissue used. More important is the condition of the middle ear at the time of the operation and the experience and skill of the surgeon. Regardless which type of tissue is used, 90% to 95% of good anatomical healing can be achieved. The author of this article performed more than 7,000 cartilage myringoplasties and presents his experience and alternatives of cartilage use in the eardrum reconstructions. He introduces three types of cartilage grafts: 1) island cartilage graft, 2) ring cartilage graft, and 3) double island cartilage graft. Laryngoscope, 2009