Management of chronic perforation and severe posterior and/or attic Retraction Pocket (RP) or atelectasis of the tympanic membrane continues to be one of the most difficult problems for otologists.To analyse the usefulness of the tympanic membrane reconstruction with tragal cartilage.The study included 27 patients with chronic perforation or severe RP operated by the same surgeon, using tragal cartilage tympanoplasty. Seven supplementary procedures were required for recurrent cholesteatoma (second-look surgery).There has been no recurrence of the retraction and the perforation. Nineteen ossicular reconstructions were necessary with acceptable hearing results.Tragal cartilage has made a significant improvement in the tympanic membrane reconstruction procedure. A large thin cartilage combined with a titanium prosthesis can provide an excellent anatomical result, perfect stability and good functional outcome. When the eardrum is intact, we still use allografts of costal cartilage for the management of the retraction pocket or titanium prosthesis.