It has already passed more than twenty years since tympanoplasty, originated by Wullstein and Milner in the middle of this century, was almost concurrently reported in Japan by Shuji Goto, Kazama, et al. During this period many basic studies have been made and operation methods have been developed to the present stage where about fifteen different kinds are reported. However, it is rather difficult to understand and master each of these methods, because they have their respective indications and lack an orderly relationship among them. Therefore, a systematic arrangement which includes every step of procedures, from the judgement of indication to the choice of operation methods, has been expected. From this reason we suggest a systematized procedure for tympanoplasty, as shown in Figure 2. If we follow this procedure, various methods of operation can be applied depending on the changes occurring during operation. Good results have been at-tained in our department.