Objective: To investigate the safety and efficacy of endoscopic revision tympanoplasty for recurrent perforations after tympanoplasty. Methods: A retrospective analysis was conducted on 18 cases (18 ears) of patients with recurrent perforations following tympanoplasty, treated by the Department of Otology at Xiangya Hospital 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. 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 used in 12 cases, and a cavum conchal cartilage-perichondrium complex graft was used in 6 cases. 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 a postoperative air-bone gap of (12.15 ± 7.70) dB, indicating a statistically significant difference (t=12.232, p<0.05). Intraoperative exploration revealed varying degrees of adhesion in the tympanic cavity in 10 cases; 3 cases lacked a complete chorda tympani nerve structure, and 2 cases experienced chorda tympani nerve injury.Conclusion: 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. However, care should be taken to protect the chorda tympani nerve to avoid iatrogenic damage. In cases where tragus cartilage is not available, cavum conchae cartilage is an ideal and suitable alternative graft material for tympanic membrane repair.