Objective: to evaluate the mediolateral tympanoplasty for reconstruction of anterior tympanic membrane perforations comparing the anterior versus posterior canal wall approach in terms of graft take and hearing improvement. Study design and settings: comparative study of 40 patients who underwent the mediolateral tympanoplasty at Kasr-Alainy University Hospitals from 2007 to 2011, all patients underwent preoperative and postoperative audiograms. Patients were divided randomly into 2 groups, group(1) 20 patients underwent(mediolateral tympanoplasty through posterior tympanomeatal flap) group(2) 20patients underwent(mediolateral tympanoplasty through anterior tympanomeatal flap), patients were followed for at least 24 months, outcome was considered successful if the tympanic membrane is intact and postoperative ABG < 30 dB. Results: the successful rate was (95%) in group (1) there was one patient of graft failure, the successful rate was (100%) in group (2) no graft failure& one patient postoperative ABG < 30 dB in group (1) and 2 patients postoperative ABG < 30 dB in group (2) and no recorded serious complications as lateralization, blunting, cholesteatoma or SNHL. Conclusion and recommendations: mediolateral tympanoplasty is a hybrid between medial and lateral graft methods that allows the advantages of both, it avoids lateralization and blunting of the graft