The operations were almost always performed under local anaesthesia. The procedure, which is bloodless and painless, is described in detail. The material is taken via an endaural incision and causes little trauma. Tragal perichondrium, which can be reinforced by adherent cartilage, is suitable for apposition to manubrium and to the anterior tympanic sulcus due to inherent properties such as bradytrophia, natural concavity and the absence of contraction or swelling. Autologous cartilage was usually used for interpositions. The results were satisfactory with respect to healing and function. There were 3.25% perforations, and 6.7% (n = 283) in subtotal tympanic membrane defects. In cholesteatoma operations the recurrence was only 5%; this may be due to the prevalence of small cholesteatomas and the almost constant use of an open technique. A socially acceptable hearing level (less than or equal to 35 dB) was obtained in 62.7% in the short term.