Primary Objective: Compare 6-month graft success rates between 0.5 mm sliced and 1.8 mm full-thickness tragal cartilage grafts.(3) H1: Sliced cartilage yields ≥90% success versus ≤80% for full-thickness.(3) H0: No difference between arms.

Secondary Objectives:

• PTA-ABG closure at 6/12 months.(4)
• Speech discrimination score improvement.(4)
• Operative time.(6)

chronic suppurative otitis media with tympanic membrane perforation impacts a large number of adults worldwide, more in rural Upper Egypt due to recurrent infections.(1) These perforations cause ongoing ear discharge, hearing impairment, quality-of-life decline, and increased healthcare costs.(1) Conventional temporalis fascia grafting achieves 80-90% success in small defects but drops below 70% for subtotal/large perforations (>50%tympanic membrane area) or with Eustachian tube issues.(2) Tragal cartilage grafting offers superior durability, with meta-analyses showing 92-98% closure rates versus 82-88% for fascia graft .(3) Full-thickness cartilage (>1.5 mm), however, risks acoustic mass-loading, worsening high-frequency hearing by 8-12 dB at 4 kHz.(4) Partial-thickness slicing (0.4-0.6 mm) maintains strength while enhancing sound transmission, as shown in clinical series.(5) Endoscopic approaches further improve visualization and reduce operative trauma.(6) No randomized trials compare sliced versus full-thickness tragal cartilage in adult endoscopic tympanoplasty.(7,8) This pilot study fills that gap, optimizing technique for local needs before

Inclusion Criteria:

• Age 18-65 years.
• safe chronic perforation ≥6 months.
• Subtotal (25-75%) or large (>75%) pars tensa defect.
• Dry ear ≥3 months (culture-negative).
• Intact ossicles, healthy mucosa.
• Viable tragal cartilage.
• Informed written consent capability.

Exclusion Criteria:

• unsafe otitis,
• active discharge,
• Eustachian dysfunction e.g cleft palate,
• ossicular defects
• prior surgery,
• unfit patients
• non-compliance

Inclusion (all required):

• Age 18-65 years.
• safe chronic perforation ≥6 months.
• Subtotal (25-75%) or large (>75%) pars tensa defect.
• Dry ear ≥3 months (culture-negative).
• Intact ossicles, healthy mucosa.
• Viable tragal cartilage.
• Informed written consent capability.

Exclusion criteria :

• unsafe otitis,
• active discharge,
• Eustachian dysfunction e.g cleft palate,
• ossicular defects
• prior surgery,
• unfit patients
• non-compliance