Elle consiste à reconstruire le tympan au moyen d'une greffe de tissu prélevé chez le patient.
Les principaux tissus utilisés sont : l'enveloppe du muscle de derrière l'oreille appelée fascia temporal, l'enveloppe du cartilage de l'oreille appelée périchondre ou le cartilage lui-même.
Une greffe prélevée au-dessus de l'oreille et parfois également aussi au niveau du cartilage de la conque permet de réparer la zone qui présente la perforation. La technique utilisée dépend de l'importance et de la localisation de la perforation.
En cas d'atteinte de la chaine ossiculaire , une prothèse ossiculaire (ossiculoplastie) est nécessaire pour permettre de remettre en continuité la membrane du tympan, la chaine ossiculaire et l'oreille interne.
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