Background: Chronic otitis media leads to tympanic membrane [TM] perforation which impairs hearing and predisposes to recurrent infections. Large subtotal and total perforations are challenging to repair. 
Aim of the study: The aim of this work is to assess the efficacy of endoscopic double door tympanoplasty for Subtotal and Total TM Perforations as regard to graft uptake and hearing results.
Materials and Methods: This prospective study was conducted on 40 ears with subtotal and total TM perforation that underwent double door tympanoplasty. Graft uptake, postoperative air-bone gap and postoperative complications were assessed.
Results: A total of 36 patients [90%] achieved successful graft uptake, while 4 patients [10%] experienced failed graft uptake, indicating a successful outcome. Post-operative audiogram air-bone gap mean is 12.25 ± 1.43 dB. The mean change from pre-operative audiogram readings is 20.58± 1.69 dB. Compared to pre-operative. The post-operation compliance mean is 11.85 ± 2.77 mL. The mean difference from pre-operative compliance is 8.68 ± 3.04 mL. External ear infection rates drop from 15% after one week to 5% at three months. At three months, 7.5% of respondent's report discomfort, down from 30% at one week [p= 0.0095].
Conclusion: Double door tympanoplasty is an effective technique for repairing large subtotal and total perforations with high graft success rates and significant air conduction improvement. It provides excellent structural and vascularized support combined with a double-layer water tight seal.