Recurrent cholesteatoma following atticotomy or combined-approach tympanoplasty remains a significant problem. The importance of closing defects created by surgery or disease in the posterosuperior bony canal is recognized, and numerous materials and techniques have been advocated. Our experience with a composite autograft of tragal cartilage and perichondrium in 40 ears is presented after 1 to 6 years follow-up. The composite autograft performed satisfactorily in 38 cases. In no case did recurrent cholesteatoma develop at the site of a defect that had been obliterated by the autograft.