Introduction: Several techniques have been used for repairing tympanic membrane perforations starting from chemical cauterization of the edges of the perforation to the use of autologous graft materials such as temporalis muscle fascia, perichondrium and cartilage. Aim: To present our approach of combined use of cartilage perichondrium graft (button graft) and chemical cauterization with trichloroacetic acid (TCA) for repair small and medium sized perforations. Materials and Methods: In this study 80 patients with small and medium sized TM perforations included and divided into two groups. In the study group button graft (BG) combined with TCA cauterization was performed while conventional temporalis fascia graft (TFG) underlay myringoplasty was used in the control group. We compared the operative time, time needed for resuming usual physical activity, time needed for graft epithelialization and postoperative anatomical and functional restoration. Results: Mean operative time was 13.70±2.30 minutes in BG with TCA group and 42.40±6.45 minutes in TFG group (P value <0.001). Time needed for complete epithelization of the graft was (12.00±1.50 days) in BG with TCA approach and (21.40±2.20 days) in TFG myringoplasty (P value <0.001). There was no significant difference between both techniques as regard anatomical and functional restoration. Conclusion: Combined use of cartilage perichondrium graft and chemical cauterization with TCA is an effective technique which decreases operative time, allow for rapid postoperative healing with comparable anatomical and functional results.