THE JUNE 1961 issue of Laryngoscope contained a paper entitled "A New System of Tympanoplasty Using Vein Graft"1 which described a single stage transmeatal method of anatomic reconstruction of the middle ear in patients with chronic ear disease. The results of this method were encouraging as 77 of 90 patients (86%) followed for 6 to 12 months had a bone-air gap closure of 15 db or less. Those patients (45) followed for a shorter period achieved this hearing result in 60%. 176 patients returned for follow-up study over the entire period and it is with these we are concerned because the majority of the failures are included in this number. Of these, 104 (59%) had a single operation as described in the original paper which accomplished satisfactory hearing for 79% (Table 2). In the original group, 72 patients (32%) had further surgery because of poor postoperative hearing. This group