Backgrounds and Aims: Tympanoplasty techniques include either an underlay or onlay approaches using temporalis fascia or perichondrium as grafts. Roland Eavey in 1998 described a transcanal cartilage butterfly inlay tympanoplasty technique in children. This technique was found to be effective to close tympanic membrane perforations, more comfortable and less morbid (no external canal incisions). The aim of this study was evaluate the efficacy of inlay cartilage tympanoplasty compared with underlay tympanoplasty. Patients and Methods: A randomized study of inlay cartilage tympanoplasty was carried out from December 1998 to March 2000. Seventy tympanoplasties were performed in adult patients to close small to medium tympanic membrane perforations, being 34 inlay cartilage and 36 underlay tympanoplasties. The main outcomes were the take rate evaluated at 30th postoperative day and the postoperative audiometric results at 2nd postoperative month. Results: The cartilage tympanoplasty resulted in an 88.2% success rate and the underlay tympanoplasty in 86.1%, when outcome measure was carried out at 30-day postoperative period (p=0.8). After a mean follow-up of 7.5±3.8 months (ranged from 3 to 16 months) the take rate was 85,3% in the cartilage tympanoplasty and 83.3% in the underlay tympanoplasty (p=0.8). In the group of patients submitted to the cartilage and underlay tympanoplasty, respectively, there was closure of the air-bone gap to within 10 dB in 64.7% and 75%, to within 20 dB in 94.1% and 97.2%. In only 2 cases (5.9%) and 1 case (2.8%) was the air-bone gap greater than 20 dB. No statistical difference was observed between the groups concerning the hearing (p=0.6). Conclusion: The take rate and audiometric results following inlay butterfly cartilage tympanoplasty or underlay tympanoplasty were similar. Inlay butterfly cartilage tympanoplasty did not require general anesthesia, was less expensive, free of adverse effects and more comfortable for the patient.