Objective To investigate the safety and efficacy of endoscopic revision tympanoplasty for recurrent perforation after tympanoplasty.Methods A retrospective analysis was conducted on 18 patients (18 ears) with recurrent perforation after tympanoplasty admitted in department of otology from August 2019 to June 2023. Endoscopic revision tympanoplasty was performed using a tragal or cavum conchal cartilage-perichondrium complex graft. Postoperative observations included the healing status of the tympanic membrane, hearing recovery, and the occurrence of surgical complications. The data were analyzed using SPSS 26.0 software.Results Among the 18 patients, 12 underwent Type Ⅰ tympanoplasty and 6 underwent Type Ⅱ tympanoplasty. During the surgery, a tragal cartilage-perichondrium complex graft was applied in 12 cases, and a cavum conchal cartilage-perichondrium complex graft was used in 6 cases. Intraoperative exploration revealed tympanic adhesions of different degrees in 10 patients, absence of complete tympanic cord structure in 3 and tympanic cord nerve injury in 2. The tympanic membrane healing rate was 100% at the 6-month follow-up. The mean preoperative air-bone gap was (37.15 ±8.79) dB, which significantly decreased to (12.15 ±7.70) dB postoperatively, indicating a statistically significant difference (t=12.232, P<0.05).Conclusions Endoscopic revision tympanoplasty using a tragal or cavum conchal cartilage-perichondrium complex graft is safe and effective, with good postoperative restoration of tympanic membrane morphology and function. Attention should be paid to protecting the tympanic cord nerve during operation to avoid iatrogenic damage. When tragus cartilage is not available, cavum conchae cartilage is an ideal alternative material for tympanic membrane repair.